1023015690 NPI number — DR. DIAMONDIS JOHN PAPADOPOULOS M.D.

Table of content: DR. DIAMONDIS JOHN PAPADOPOULOS M.D. (NPI 1023015690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023015690 NPI number — DR. DIAMONDIS JOHN PAPADOPOULOS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAPADOPOULOS
Provider First Name:
DIAMONDIS
Provider Middle Name:
JOHN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023015690
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
875 JOHNSON FERRY RD NE
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30342-1418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-257-9933
Provider Business Mailing Address Fax Number:
404-257-9931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
875 JOHNSON FERRY RD NE
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30342-1418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-257-9933
Provider Business Practice Location Address Fax Number:
404-257-9931
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ND0101X , with the licence number:  22773 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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