Healthcare Provider Details

I. General information

NPI: 1528229184
Provider Name (Legal Business Name): GEORGIA GIANAKAKOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 PRUDENTIAL DR FL 10 CREDENTIALING DEPARTMENT
JACKSONVILLE FL
32207-8329
US

IV. Provider business mailing address

PO BOX 41113
JACKSONVILLE FL
32203-1113
US

V. Phone/Fax

Practice location:
  • Phone: 904-398-5404
  • Fax: 904-391-5545
Mailing address:
  • Phone: 904-376-4400
  • Fax: 904-391-5545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01096195A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number268597
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME104973
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: