Provider Demographics
NPI:1750453254
Name:GELLER, BRIAN ALEXANDER (DO)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ALEXANDER
Last Name:GELLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 SAVOY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1071
Mailing Address - Country:US
Mailing Address - Phone:706-253-3100
Mailing Address - Fax:706-253-3101
Practice Address - Street 1:134 MOUNTAINSIDE VILLAGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-8694
Practice Address - Country:US
Practice Address - Phone:706-253-3100
Practice Address - Fax:706-253-3101
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA66493207RH0003X, 207RH0003X
MA230980207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA676330481EMedicaid
GA003130369AMedicaid
GA003130369BMedicaid
GA202I831487Medicare PIN
MAAA92921OtherHARVARD PILGRIM HEALTHCAR
MA000147301Medicare PIN