Organization
GERIATRIC ESSENTIALS, PC
Active
Parent organization
GERIATRIC ESSENTIALS PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
GERIATRIC ESSENTIALS PC
Authorized official
SUSAN K LOVELACE (BILLING/CREDENTIALING)
(731) 410-7719
Entity
Organization
Contact information
Practice address
402 W FARTHING ST, MAYFIELD, KY 42066-2900
(731) 571-8808
Mailing address
PO BOX 12432, JACKSON, TN 38308-0141
(731) 410-7719
(731) 214-1816
Taxonomy
Speciality
Code
Description
License number
State
2084P0805X
Geriatric Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100689200
—
KY
Enumeration date
11/09/2020
Last updated
11/09/2020
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