Healthcare Provider Details

I. General information

NPI: 1750453254
Provider Name (Legal Business Name): BRIAN ALEXANDER GELLER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 MOUNTAINSIDE VILLAGE PKWY STE 100
JASPER GA
30143-8694
US

IV. Provider business mailing address

1835 SAVOY DR STE 300
ATLANTA GA
30341-1071
US

V. Phone/Fax

Practice location:
  • Phone: 706-253-3100
  • Fax: 706-253-3101
Mailing address:
  • Phone: 706-253-3100
  • Fax: 706-253-3101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number66493
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: