Provider Demographics
NPI:1083381362
Name:VERNARDAKIS, GEORGIA MARY
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:MARY
Last Name:VERNARDAKIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 S DELAWARE AVE APT 1831
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-2476
Mailing Address - Country:US
Mailing Address - Phone:913-258-0605
Mailing Address - Fax:
Practice Address - Street 1:425 S DELAWARE AVE APT 1831
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-2476
Practice Address - Country:US
Practice Address - Phone:913-258-0605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer