Provider Demographics
NPI:1295963759
Name:JUSTICE, GERI E (MD)
Entity type:Individual
Prefix:DR
First Name:GERI
Middle Name:E
Last Name:JUSTICE
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:PO BOX 1189
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-1189
Mailing Address - Country:US
Mailing Address - Phone:229-382-8822
Mailing Address - Fax:229-387-0377
Practice Address - Street 1:1006 GREENFIELD DR
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3794
Practice Address - Country:US
Practice Address - Phone:229-382-8822
Practice Address - Fax:229-387-0377
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA68649207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program