Healthcare Provider Details

I. General information

NPI: 1629258058
Provider Name (Legal Business Name): DALLAS GERIATRICS ASSOCIATES, P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 SHEPHERD LN
BALCH SPRINGS TX
75180-3423
US

IV. Provider business mailing address

445 E. FM 1382 SUITE # 3354
CEDAR HILL TX
75104
US

V. Phone/Fax

Practice location:
  • Phone: 214-325-1969
  • Fax: 972-291-0019
Mailing address:
  • Phone: 972-900-0747
  • Fax: 972-393-5234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberJ6213
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JYOTSNA S PRASAD
Title or Position: PRESIDENT
Credential: MD
Phone: 972-900-0747