Provider Demographics
NPI:1306064530
Name:KALAITZIDIS, GEORGINA HALVAS (MD)
Entity type:Individual
Prefix:
First Name:GEORGINA
Middle Name:HALVAS
Last Name:KALAITZIDIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GEORGINA
Other - Middle Name:
Other - Last Name:HALVAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 165
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-3301
Practice Address - Country:US
Practice Address - Phone:678-442-2025
Practice Address - Fax:678-442-2031
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA56186207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine