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General NPI Number Information
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NPI Number | 1417387648
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Entity Type | Organization
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Legal Business Name | PRIMARILY GERIATRICS, LLC
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Dates
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Enumeration Date | 11/25/2013
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Last Update Date | 09/13/2018
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Provider Practice Location Address
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Address Line | 1501 7TH ST SE
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City | DECATUR
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State | AL
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Zip | 35601-3378
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Country | US
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Telephone | 256-355-5315
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 7TH ST SE
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City | DECATUR
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State | AL
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Zip | 35601-3378
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Country | US
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Telephone | 256-355-5315
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. RUSSELL THOMAS BARR
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Credential |
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Telephone | 256-260-9535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 12034
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License Number State | AL
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