Provider Demographics
NPI:1366136301
Name:HANEY, GEOFFREY BLAKE
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:BLAKE
Last Name:HANEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 INVERNESS PKWY
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-7520
Mailing Address - Country:US
Mailing Address - Phone:205-454-6066
Mailing Address - Fax:
Practice Address - Street 1:2018 INVERNESS PKWY
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-7520
Practice Address - Country:US
Practice Address - Phone:205-391-7994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL485320343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)