Provider Demographics
NPI:1922792902
Name:GEORGIADIS, YANOULA MARIA
Entity Type:Individual
Prefix:
First Name:YANOULA
Middle Name:MARIA
Last Name:GEORGIADIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 OZARK DR
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:IN
Mailing Address - Zip Code:46341-7205
Mailing Address - Country:US
Mailing Address - Phone:219-307-0786
Mailing Address - Fax:
Practice Address - Street 1:638 OZARK DR
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:IN
Practice Address - Zip Code:46341-7205
Practice Address - Country:US
Practice Address - Phone:219-307-0786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program