Provider Demographics
NPI:1649687179
Name:TUSCALOOSA GERIATRICS, P.C.
Entity type:Organization
Organization Name:TUSCALOOSA GERIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GERIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-657-0711
Mailing Address - Street 1:PO BOX 20335
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35402-0335
Mailing Address - Country:US
Mailing Address - Phone:205-657-0711
Mailing Address - Fax:
Practice Address - Street 1:4000 CAROUSEL CIR
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2997
Practice Address - Country:US
Practice Address - Phone:205-657-0711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27429207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I19441Medicare UPIN