Provider Demographics
NPI:1528229184
Name:GIANAKAKOS, GEORGIA (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGIA
Middle Name:
Last Name:GIANAKAKOS
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:PO BOX 41113
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-1113
Mailing Address - Country:US
Mailing Address - Phone:904-376-4400
Mailing Address - Fax:904-391-5545
Practice Address - Street 1:841 PRUDENTIAL DR FL 10
Practice Address - Street 2:CREDENTIALING DEPARTMENT
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8329
Practice Address - Country:US
Practice Address - Phone:904-398-5404
Practice Address - Fax:904-391-5545
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1049732084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0017899-00Medicaid
FLCJ304YMedicare PIN
FLCJ304YMedicare PIN