MEDICARE: GEORGE PATIDES A.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AP917	FL

General Provider Information

NPI Number	:	1073928677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE PATIDES A.P.

Provider Business Mailing Address
First Line	:	2819 MAHAN DR STE 102
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-5492
Country	:	US
Telephone Number	:	850-877-8980
Fax Number	:	888-972-7513

Provider Business Practice Location Address
First Line	:	2819 MAHAN DR STE 102
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-5492
Country	:	US
Telephone Number	:	850-877-8980
Fax Number	:	888-972-7513

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2014
Last Update Date	:	06/23/2014

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Directions to “ GEORGE PATIDES A.P.” Practice Location

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