Healthcare Provider Details

I. General information

NPI: 1770286809
Provider Name (Legal Business Name): AMELIA GEORGAS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9660 WICKER AVE
SAINT JOHN IN
46373-9487
US

IV. Provider business mailing address

9660 WICKER AVE
SAINT JOHN IN
46373-9487
US

V. Phone/Fax

Practice location:
  • Phone: 219-365-1166
  • Fax: 219-226-2222
Mailing address:
  • Phone: 219-365-1166
  • Fax: 219-226-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number02009119A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: