Provider Demographics
NPI:1851313431
Name:TARIRAH, GERALD T (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:T
Last Name:TARIRAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 PINE STREET
Mailing Address - Street 2:SUITE 560
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201
Mailing Address - Country:US
Mailing Address - Phone:478-745-9998
Mailing Address - Fax:478-745-9981
Practice Address - Street 1:770 PINE STREET
Practice Address - Street 2:SUITE 560
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201
Practice Address - Country:US
Practice Address - Phone:478-745-9998
Practice Address - Fax:478-745-9981
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19405207RP1001X
GA065904207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003110501CMedicaid
MS02404007Medicaid
GA003110501FMedicaid
GAP01686239OtherRAILROAD MEDICARE PTAN
MS02404007Medicaid
GA003110501FMedicaid
MS110001998Medicare PIN
GAI59337Medicare UPIN
GA202I291121Medicare PIN