Healthcare Provider Details

I. General information

NPI: 1831499409
Provider Name (Legal Business Name): LEONIDAS PANAGIOTAKOPOULOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 CHURCH ST
DECATUR GA
30030-1870
US

IV. Provider business mailing address

PO BOX 9
MAPLEWOOD NJ
07040-0009
US

V. Phone/Fax

Practice location:
  • Phone: 404-445-0350
  • Fax: 877-480-9635
Mailing address:
  • Phone: 404-445-0350
  • Fax: 877-480-9635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number67712
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number67712
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: