Healthcare Provider Details

I. General information

NPI: 1295963759
Provider Name (Legal Business Name): GERI E JUSTICE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 GREENFIELD DR
TIFTON GA
31794-3794
US

IV. Provider business mailing address

PO BOX 1189
TIFTON GA
31793-1189
US

V. Phone/Fax

Practice location:
  • Phone: 229-382-8822
  • Fax: 229-387-0377
Mailing address:
  • Phone: 229-382-8822
  • Fax: 229-387-0377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number68649
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: