Basic Information
| Provider Information | |||||||||
| NPI: | 1295830644 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEARY | ||||||||
| FirstName: | LOUISE | ||||||||
| MiddleName: | ROACH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 59 ALISON DRIVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | ALEXANDER CITY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350103369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563292938 | ||||||||
| FaxNumber: | 2563292938 | ||||||||
| Practice Location | |||||||||
| Address1: | 3316 HIGHWAY 280 | ||||||||
| Address2: | |||||||||
| City: | ALEXANDER CITY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350103369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563292938 | ||||||||
| FaxNumber: | 2563292938 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 4307 | AL | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 51058954 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER | 000058954 | 05 | AL | MEDICAID |