Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | 22773 | GA |
NPI | 1023015690 |
---|---|
Provider Name | Dr. Diamondis John Papadopoulos |
First Address | Atlanta, GA 30342-1418 |
Second Address | Atlanta, GA 30342-1418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 21/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D17473 | (02) | GA |