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General NPI Number Information
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NPI Number | 1205331089
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Entity Type | Individual
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Provider Name | PETROS KOUTSOGIANNIS DO
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Gender | Male
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 1604 MEDICAL DR
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City | LAURINBURG
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State | NC
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Zip | 28352-5524
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Country | US
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Telephone | 910-276-4611
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Fax | 910-277-4244
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Provider Business Mailing Address
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Address Line | 4601 PARK RD STE 300
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City | CHARLOTTE
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State | NC
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Zip | 28209-2290
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Country | US
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Telephone | 704-323-2248
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 2024-01911
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License Number State | NC
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