Provider Demographics
NPI:1508824392
Name:VERRAS, ATHANASIOS (MD)
Entity Type:Individual
Prefix:
First Name:ATHANASIOS
Middle Name:
Last Name:VERRAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ATHAN
Other - Middle Name:
Other - Last Name:VERRAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2007 MONTREAL RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5253
Mailing Address - Country:US
Mailing Address - Phone:770-491-1285
Mailing Address - Fax:770-491-3164
Practice Address - Street 1:2007 MONTREAL RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:33084
Practice Address - Country:US
Practice Address - Phone:770-491-1285
Practice Address - Fax:770-491-3164
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022908208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F32104Medicare UPIN