Provider Demographics
NPI:1013991595
Name:CRABAPPLE INTERNAL MEDICINE, PC
Entity Type:Organization
Organization Name:CRABAPPLE INTERNAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:FORREST
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-594-1233
Mailing Address - Street 1:45 W CROSSVILLE RD
Mailing Address - Street 2:SUITE 501
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2964
Mailing Address - Country:US
Mailing Address - Phone:770-594-1233
Mailing Address - Fax:770-594-0037
Practice Address - Street 1:45 W CROSSVILLE RD
Practice Address - Street 2:SUITE 501
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2964
Practice Address - Country:US
Practice Address - Phone:770-594-1233
Practice Address - Fax:770-594-0037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA43135207Q00000X
GA023230207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty