Provider Demographics
NPI:1720490709
Name:DIAKAKIS, GEORGIA MARINIS (RD)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:MARINIS
Last Name:DIAKAKIS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 N FRANKLIN ST
Mailing Address - Street 2:APT 1009
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-8793
Mailing Address - Country:US
Mailing Address - Phone:847-962-5726
Mailing Address - Fax:
Practice Address - Street 1:849 N FRANKLIN ST
Practice Address - Street 2:APT 1009
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-8793
Practice Address - Country:US
Practice Address - Phone:847-962-5726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164005446133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric