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General NPI Number Information
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NPI Number | 1568093672
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Entity Type | Organization
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Legal Business Name | PREMIER GERIATRIC SOLUTIONS PLLC
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Dates
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Enumeration Date | 01/28/2020
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Last Update Date | 02/09/2021
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Provider Practice Location Address
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Address Line | 6701 PETERS CREEK RD STE 110
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City | ROANOKE
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State | VA
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Zip | 24019-4060
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Country | US
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Telephone | 800-765-7130
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Fax | 201-228-9980
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Provider Business Mailing Address
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Address Line | 6701 PETERS CREEK RD STE 110
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City | ROANOKE
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State | VA
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Zip | 24019-4060
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Country | US
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Telephone | 800-765-7130
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Fax | 201-228-9980
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRADLEY JACKSON GOAD
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Credential | DO
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Telephone | 540-488-2200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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