Healthcare Provider Details

I. General information

NPI: 1205178464
Provider Name (Legal Business Name): GEORGE ZABAKOLAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 S 12TH ST
FORT SMITH AR
72901-4702
US

IV. Provider business mailing address

612 S 12TH ST
FORT SMITH AR
72901-4702
US

V. Phone/Fax

Practice location:
  • Phone: 479-424-3193
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-9986
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.145200
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA170433
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: