Provider Demographics
NPI:1679509707
Name:GEATER, BARBARA ELLA (MD)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:ELLA
Last Name:GEATER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 S LAUDERDALE ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38106-7517
Mailing Address - Country:US
Mailing Address - Phone:901-948-5558
Mailing Address - Fax:901-774-9031
Practice Address - Street 1:2245 S LAUDERDALE ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38106-7517
Practice Address - Country:US
Practice Address - Phone:901-948-5558
Practice Address - Fax:901-774-9031
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28070207Q00000X
MS14900207Q00000X
AL18544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3049364OtherBLUE CROSS BLUE SHIELD
TN3802177Medicaid
MS0118616Medicaid
3802178Medicare ID - Type Unspecified
MS0118616Medicaid
F91477Medicare UPIN