Provider Demographics
NPI:1972650018
Name:ANGELOPOULOS, JOHN GEORGE (EDD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GEORGE
Last Name:ANGELOPOULOS
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 RUSTIC RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-7732
Mailing Address - Country:US
Mailing Address - Phone:423-341-2673
Mailing Address - Fax:423-929-9120
Practice Address - Street 1:323 W WALNUT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6760
Practice Address - Country:US
Practice Address - Phone:423-341-2673
Practice Address - Fax:423-929-9120
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLEAP#97101YM0800X
TN520 SENIOR PSYCH EXM103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health