Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | CHIRO007542 | GA |
NPI | 1184770620 |
---|---|
Provider Name | Dr. Alexander Gebhardt |
First Address | Roswell, GA 30075-3037 |
Second Address | Roswell, GA 30075-3037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 09/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CHIRO007542 | STATE OF GEORGIA LICENSE (01) | GA |