Provider Demographics
NPI:1588207476
Name:THE GERALDINE CLINIC LLC
Entity type:Organization
Organization Name:THE GERALDINE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:256-659-2000
Mailing Address - Street 1:41263 AL HIGHWAY 75 STE D
Mailing Address - Street 2:
Mailing Address - City:GERALDINE
Mailing Address - State:AL
Mailing Address - Zip Code:35974-3724
Mailing Address - Country:US
Mailing Address - Phone:256-659-2000
Mailing Address - Fax:256-659-2002
Practice Address - Street 1:41263 AL HIGHWAY 75 STE D
Practice Address - Street 2:
Practice Address - City:GERALDINE
Practice Address - State:AL
Practice Address - Zip Code:35974-3724
Practice Address - Country:US
Practice Address - Phone:256-659-2000
Practice Address - Fax:256-659-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-23
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty