Provider Demographics
NPI:1093199358
Name:TSIPOTIS, EVANGELOS
Entity Type:Individual
Prefix:
First Name:EVANGELOS
Middle Name:
Last Name:TSIPOTIS
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 1:1120 15TH ST # AD-2226
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0004
Mailing Address - Country:US
Mailing Address - Phone:706-721-0207
Mailing Address - Fax:706-723-0382
Practice Address - Street 1:1120 15TH ST # AD-2226
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-0207
Practice Address - Fax:706-723-0382
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA264017207R00000X
MDD0091381207RG0100X
GA91784207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine