Provider Demographics
NPI:1083634786
Name:KATOPES, MICHAEL G (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:KATOPES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:203 WOODPARK PL BLDG C
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3764
Mailing Address - Country:US
Mailing Address - Phone:770-926-4150
Mailing Address - Fax:770-874-0452
Practice Address - Street 1:203 WOODPARK PL BLDG C
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3764
Practice Address - Country:US
Practice Address - Phone:770-926-4150
Practice Address - Fax:770-874-0452
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA025449207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD29910Medicare UPIN