Provider Demographics
NPI:1164642096
Name:HATZOUDIS, GEORGIOS (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGIOS
Middle Name:
Last Name:HATZOUDIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W SAGAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-3514
Mailing Address - Country:US
Mailing Address - Phone:863-983-3434
Mailing Address - Fax:863-983-2139
Practice Address - Street 1:1138 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14904-2502
Practice Address - Country:US
Practice Address - Phone:607-734-2695
Practice Address - Fax:607-734-2917
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME144433208600000X
NY261793208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1701924OtherMEDICA
SD7302220Medicaid
P00451957OtherRR MEDICARE
ND12976Medicaid
SD4992486OtherBLUE CROSS SOUTH DAKOTA
NY03412282Medicaid
SD370624200OtherDEPT OF LABOR
SD412871051724OtherPREFERRED ONE
SD1164642096OtherARAZ/ AMERICA'S PPO
SD253814OtherMIDLANDS CHOICE
MN688453000Medicaid
SD7054OtherDAKOTACARE
HP79711OtherHEALTHPARTNERS
MN70L87HAOtherBLUE CROSS
MN70L87HAOtherCC SYSTEMS/ BLUE PLUS
P00451957OtherRR MEDICARE
SD412871051724OtherPREFERRED ONE