Provider Demographics
NPI:1679637912
Name:GERIATRIC ASSOCIATES OF MONTGOMERY, PC
Entity Type:Organization
Organization Name:GERIATRIC ASSOCIATES OF MONTGOMERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-277-7665
Mailing Address - Street 1:1230 CARMICHAEL WAY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-3671
Mailing Address - Country:US
Mailing Address - Phone:334-277-7665
Mailing Address - Fax:334-277-7142
Practice Address - Street 1:1230 CARMICHAEL WAY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3671
Practice Address - Country:US
Practice Address - Phone:334-277-7665
Practice Address - Fax:334-277-7142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALI937Medicare PIN