Provider Demographics
NPI:1164085270
Name:GEORGALLIDES, ALEXIS (MD)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:GEORGALLIDES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4648 OLD CLEAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89705-6846
Mailing Address - Country:US
Mailing Address - Phone:724-766-0823
Mailing Address - Fax:
Practice Address - Street 1:625 INNOVATION DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2215
Practice Address - Country:US
Practice Address - Phone:775-799-7320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV22070207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty