Provider Demographics
NPI:1245785815
Name:DR. GEORGE EMANOILIDIS EPIC SERVICES PA
Entity Type:Organization
Organization Name:DR. GEORGE EMANOILIDIS EPIC SERVICES PA
Other - Org Name:DR. GEORGE EMANOILIDIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:EMANOILIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:863-243-3198
Mailing Address - Street 1:21 RYANT BLVD
Mailing Address - Street 2:SUITE 21
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-8075
Mailing Address - Country:US
Mailing Address - Phone:863-243-3198
Mailing Address - Fax:
Practice Address - Street 1:21 RYANT BLVD
Practice Address - Street 2:SUITE 21
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-8075
Practice Address - Country:US
Practice Address - Phone:863-243-3198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8561103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGN537AOtherMEDICARE PTAN