Basic Information
| Provider Information | |||||||||
| NPI: | 1972653152 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GELLER | ||||||||
| FirstName: | SCHUYLER | ||||||||
| MiddleName: | KEITH | ||||||||
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| Credential: | M.D., M.P.H. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2825 CLINCH VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | TREADWAY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378812026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237540747 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 917 W WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376046527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234396464 | ||||||||
| FaxNumber: | 4234397118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2007 | ||||||||
| LastUpdateDate: | 10/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 0101254986 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207RG0300X | 12189 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207RG0300X | 010256520A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 208000000X | 12189 | TN | N | Allopathic & Osteopathic Physicians | Pediatrics | 207RA0401X | 12189 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine |
No ID Information.