Healthcare Provider Details

I. General information

NPI: 1942204730
Provider Name (Legal Business Name): GERALDINE OMEARA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2260 WRIGHTSBORO RD
AUGUSTA GA
30904-4764
US

IV. Provider business mailing address

1499 WALTON WAY STE 1400
AUGUSTA GA
30901-2602
US

V. Phone/Fax

Practice location:
  • Phone: 706-481-7000
  • Fax:
Mailing address:
  • Phone: 706-724-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number030174
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: