Provider Demographics
NPI:1528575404
Name:GEORGIADES, JAMES CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CHRISTOPHER
Last Name:GEORGIADES
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 1:4140 PALMER PARK CIR E APT 203
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-1176
Mailing Address - Country:US
Mailing Address - Phone:330-949-9029
Mailing Address - Fax:
Practice Address - Street 1:4140 PALMER PARK CIR E APT 203
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-1176
Practice Address - Country:US
Practice Address - Phone:330-949-9029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant