Provider Demographics
NPI:1619516382
Name:FARMER, GERALDINE (MS)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:FARMER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-2504
Mailing Address - Country:US
Mailing Address - Phone:662-323-9318
Mailing Address - Fax:662-323-5553
Practice Address - Street 1:43 DR MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MS
Practice Address - Zip Code:39341-2734
Practice Address - Country:US
Practice Address - Phone:662-726-5042
Practice Address - Fax:662-726-5009
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health