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General NPI Number Information
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NPI Number | 1245541135
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Entity Type | Organization
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Legal Business Name | GERIATRICS ASSOCIATES OF GAINESVILLE INC
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Dates
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Enumeration Date | 06/25/2010
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Last Update Date | 10/07/2010
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Provider Practice Location Address
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Address Line | 6711 MILLHOPPER RD
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City | GAINESVILLE
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State | FL
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Zip | 32653-3944
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Country | US
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Telephone | 352-367-9700
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Fax | 352-367-1009
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Provider Business Mailing Address
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Address Line | PO BOX 141450
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City | GAINESVILLE
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State | FL
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Zip | 32614-1450
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Country | US
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Telephone | 352-367-9700
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Fax | 352-367-1009
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Authorized Official
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Title or Position | OWNER
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Name | WAJID KHUDDUS
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Credential | MD
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Telephone | 352-367-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME93049
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License Number State | FL
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