Provider Demographics
NPI:1568093672
Name:PREMIER GERIATRIC SOLUTIONS PLLC
Entity Type:Organization
Organization Name:PREMIER GERIATRIC SOLUTIONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:GOAD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:540-488-2200
Mailing Address - Street 1:6701 PETERS CREEK RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-4060
Mailing Address - Country:US
Mailing Address - Phone:800-765-7130
Mailing Address - Fax:201-228-9980
Practice Address - Street 1:6701 PETERS CREEK RD STE 110
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-4060
Practice Address - Country:US
Practice Address - Phone:800-765-7130
Practice Address - Fax:201-228-9980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty