Provider Demographics
NPI:1932444312
Name:LOGOTHETIS, JOY GEORGIANA (MMS, PA-C)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:GEORGIANA
Last Name:LOGOTHETIS
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:GEORGIANA
Other - Last Name:ECONOMOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MMS, PA-C
Mailing Address - Street 1:676 N SAINT CLAIR ST STE 1600
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2997
Mailing Address - Country:US
Mailing Address - Phone:312-695-8106
Mailing Address - Fax:312-695-0537
Practice Address - Street 1:676 N SAINT CLAIR ST STE 1600
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2997
Practice Address - Country:US
Practice Address - Phone:312-695-8106
Practice Address - Fax:312-695-0537
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004412363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant