Roswell Medical Group, LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

20987 Issued in GA

Legal business name

ROSWELL MEDICAL GROUP, LLC

Practice address

11040 Crabapple Rd
Roswell, GA 30075-2457

Phone

(678) 878-3551

Fax

(678) 878-3552

NPI assigned

Oct 2, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Alexander K Gebhardt, DC

Title

Owner

Phone

(678) 878-3551

Specialties & licenses 3

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1443744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491177600000",
    "number": "1275903296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11040 CRABAPPLE RD",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300752457",
            "telephone_number": "678-878-3551",
            "fax_number": "678-878-3552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11040 CRABAPPLE RD",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300752457",
            "telephone_number": "678-878-3551",
            "fax_number": "678-878-3552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSWELL MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-02",
        "last_updated": "2017-04-03",
        "status": "A",
        "authorized_official_last_name": "GEBHARDT",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-878-3551",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR007542",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "GA",
            "license": "20987",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "GA",
            "license": "26935",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Roswell, GA
• Providers in Roswell, GA by specialty
• General Practice Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.