Provider Demographics
NPI:1942287834
Name:NAKOS, DENISE JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:JOSEPH
Last Name:NAKOS
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 1:1060 WINDY HILL RD SE STE 200
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-2065
Mailing Address - Country:US
Mailing Address - Phone:770-941-7709
Mailing Address - Fax:
Practice Address - Street 1:1060 WINDY HILL RD SE STE 200
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-2065
Practice Address - Country:US
Practice Address - Phone:770-941-7709
Practice Address - Fax:770-941-6441
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042369208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00718539AMedicaid