Provider Demographics
NPI:1083985519
Name:GENERATIONS PRIMARY CARE
Entity Type:Organization
Organization Name:GENERATIONS PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:GIBSON
Authorized Official - Last Name:LOWTHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-343-6979
Mailing Address - Street 1:6531 HIGHWAY 69 S
Mailing Address - Street 2:SUITE A
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-4087
Mailing Address - Country:US
Mailing Address - Phone:205-343-6979
Mailing Address - Fax:205-345-3343
Practice Address - Street 1:6531 HIGHWAY 69 S
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-4087
Practice Address - Country:US
Practice Address - Phone:205-343-6979
Practice Address - Fax:205-345-3343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL207Q00000X
AL26476207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty