Provider Demographics
NPI:1689901597
Name:VICTOR G. POLIZOS MD PC
Entity Type:Organization
Organization Name:VICTOR G. POLIZOS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:POLIZOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-521-2445
Mailing Address - Street 1:427 MORELAND AVE NE STE 400
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1500
Mailing Address - Country:US
Mailing Address - Phone:404-521-2445
Mailing Address - Fax:404-521-0067
Practice Address - Street 1:427 MORELAND AVE NE STE 400
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-1500
Practice Address - Country:US
Practice Address - Phone:404-521-2445
Practice Address - Fax:404-521-0067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0229562080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C76817Medicare UPIN