Provider Demographics
NPI:1972603785
Name:GEORGIOU, ANASTASIOS L (MD)
Entity Type:Individual
Prefix:DR
First Name:ANASTASIOS
Middle Name:L
Last Name:GEORGIOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1804 HIGHWAY 45 BYP
Mailing Address - Street 2:SUITE 607
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-4436
Mailing Address - Country:US
Mailing Address - Phone:731-668-5335
Mailing Address - Fax:731-668-6670
Practice Address - Street 1:620 SKYLINE DR
Practice Address - Street 2:RADIATION ONCOLOGY DEPT
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3923
Practice Address - Country:US
Practice Address - Phone:731-541-6250
Practice Address - Fax:731-541-6858
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0244222085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3073988Medicaid
TNF33187Medicare UPIN
TN3073988Medicaid