Provider Demographics
NPI:1831499409
Name:PANAGIOTAKOPOULOS, LEONIDAS
Entity Type:Individual
Prefix:
First Name:LEONIDAS
Middle Name:
Last Name:PANAGIOTAKOPOULOS
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 1:215 CHURCH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3330
Mailing Address - Country:US
Mailing Address - Phone:404-445-0350
Mailing Address - Fax:877-480-9635
Practice Address - Street 1:215 CHURCH ST STE 102
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3330
Practice Address - Country:US
Practice Address - Phone:404-445-0350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-28
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA67712208000000X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty