Provider Demographics
NPI:1073928677
Name:PATIDES, GEORGE (AP)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:PATIDES
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 MAHAN DR STE 102
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5492
Mailing Address - Country:US
Mailing Address - Phone:850-877-8980
Mailing Address - Fax:888-972-7513
Practice Address - Street 1:2819 MAHAN DR STE 102
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5492
Practice Address - Country:US
Practice Address - Phone:850-877-8980
Practice Address - Fax:888-972-7513
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP917171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist