Provider Demographics
NPI:1265504716
Name:GERIATRIC SPECIALISTS LLC
Entity Type:Organization
Organization Name:GERIATRIC SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:251-675-4733
Mailing Address - Street 1:95 SHELL RD
Mailing Address - Street 2:
Mailing Address - City:SARALAND
Mailing Address - State:AL
Mailing Address - Zip Code:36571-2202
Mailing Address - Country:US
Mailing Address - Phone:251-675-4733
Mailing Address - Fax:251-679-2914
Practice Address - Street 1:1059 PALMETTO ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604
Practice Address - Country:US
Practice Address - Phone:251-675-4733
Practice Address - Fax:251-679-2914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00010425207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C73281Medicare UPIN
51054600Medicare ID - Type Unspecified