Provider Demographics
NPI:1558624247
Name:MAZOTAS, IOANNA GEORGOPOULOS (MD)
Entity Type:Individual
Prefix:DR
First Name:IOANNA
Middle Name:GEORGOPOULOS
Last Name:MAZOTAS
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:80 PEACHTREE RD STE 210
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-3160
Practice Address - Country:US
Practice Address - Phone:828-378-5600
Practice Address - Fax:828-378-5609
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI674852086X0206X
NC2018-01350208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1558624247Medicaid