Provider Demographics
NPI:1821519257
Name:VASSILYADI, PHOTIOS (MD)
Entity Type:Individual
Prefix:DR
First Name:PHOTIOS
Middle Name:
Last Name:VASSILYADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 PROSSER RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-4233
Mailing Address - Country:US
Mailing Address - Phone:931-762-5115
Mailing Address - Fax:
Practice Address - Street 1:184 PROSSER RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4233
Practice Address - Country:US
Practice Address - Phone:931-762-5115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301112627207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine