MEDICARE: NIKOLAOS PAPADANTONAKIS M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	83876	GA

General Provider Information

NPI Number	:	1861764615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKOLAOS PAPADANTONAKIS M.D

Provider Business Mailing Address
First Line	:	1365 CLIFTON RD NE BLDG B
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-5310
Country	:	US
Telephone Number	:	404-778-1526
Fax Number	:

Provider Business Practice Location Address
First Line	:	1365 CLIFTON RD NE BLDG C
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-2110
Country	:	US
Telephone Number	:	404-778-1526
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2012
Last Update Date	:	02/13/2020

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