Provider Demographics
NPI:1114183548
Name:SOUTHERN GERIATRICS, LLC
Entity Type:Organization
Organization Name:SOUTHERN GERIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:LOEWY-
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-463-5600
Mailing Address - Street 1:1310 SE MAYNARD RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-3615
Mailing Address - Country:US
Mailing Address - Phone:919-463-5600
Mailing Address - Fax:
Practice Address - Street 1:1310 SE MAYNARD RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-3615
Practice Address - Country:US
Practice Address - Phone:919-463-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty