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General NPI Number Information
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NPI Number | 1851558951
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Entity Type | Organization
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Legal Business Name | GERIATRIC CARE ASSOCIATES, LLC
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Dates
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Enumeration Date | 05/18/2008
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Last Update Date | 05/18/2008
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Provider Practice Location Address
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Address Line | 5801 SPRUCE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19139-3833
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Country | US
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Telephone | 215-471-8255
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Fax | 215-471-5506
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Provider Business Mailing Address
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Address Line | 5801 SPRUCE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19139-3833
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Country | US
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Telephone | 215-471-8255
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Fax | 215-471-5506
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Authorized Official
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Title or Position | MANAGMENT/OWNER
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Name | DR. DARRYL B. JACKSON
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Credential | M.D.
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Telephone | 215-471-8255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | MD044865L
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License Number State | PA
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