Healthcare Provider Details

I. General information

NPI: 1245541135
Provider Name (Legal Business Name): GERIATRICS ASSOCIATES OF GAINESVILLE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6711 MILLHOPPER RD
GAINESVILLE FL
32653-3944
US

IV. Provider business mailing address

PO BOX 141450
GAINESVILLE FL
32614-1450
US

V. Phone/Fax

Practice location:
  • Phone: 352-367-9700
  • Fax: 352-367-1009
Mailing address:
  • Phone: 352-367-9700
  • Fax: 352-367-1009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME93049
License Number StateFL

VIII. Authorized Official

Name: WAJID KHUDDUS
Title or Position: OWNER
Credential: MD
Phone: 352-367-9700