Provider Demographics
NPI:1669494597
Name:ALABAMA GERIATRIC SPECIALISTS INC.
Entity type:Organization
Organization Name:ALABAMA GERIATRIC SPECIALISTS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROLLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-916-0105
Mailing Address - Street 1:PO BOX 130776
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-0776
Mailing Address - Country:US
Mailing Address - Phone:205-916-0105
Mailing Address - Fax:205-718-8934
Practice Address - Street 1:1 W LAKESHORE DR STE 100
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-7271
Practice Address - Country:US
Practice Address - Phone:205-916-0105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529912710Medicaid
DA7932OtherRAILROAD MEDICARE GROUP #
AL529912710Medicaid