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General NPI Number Information
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NPI Number | 1962630814
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Entity Type | Organization
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Legal Business Name | CRABAPPLE MED, INC.
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 06/30/2009
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Provider Practice Location Address
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Address Line | 10929 CRABAPPLE RD 201B
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City | ROSWELL
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State | GA
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Zip | 30075-7657
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Country | US
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Telephone | 770-410-1444
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Fax | 678-827-0520
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Provider Business Mailing Address
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Address Line | 10929 CRABAPPLE RD 201B
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City | ROSWELL
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State | GA
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Zip | 30075-7657
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Country | US
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Telephone | 770-410-1444
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Fax | 678-827-0520
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID ALLAN REEDER
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Credential | M.D.
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Telephone | 770-410-1444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 028633
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License Number State | GA
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