Provider Demographics
NPI:1154140267
Name:GENEVA PRIMARY CARE & MED SPA
Entity type:Organization
Organization Name:GENEVA PRIMARY CARE & MED SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIVANI
Authorized Official - Middle Name:
Authorized Official - Last Name:JERATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:470-704-9687
Mailing Address - Street 1:5256 CRESSLYN RDG
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30005-2600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3275 N POINT PKWY STE 204
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4708
Practice Address - Country:US
Practice Address - Phone:706-495-1928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENEVA FAMILY MEDICINE AND AESTHETICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-07
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty