Provider Demographics
NPI:1528047792
Name:POLIZOS, VICTOR G (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:G
Last Name:POLIZOS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:427 MORELAND AVE NE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1500
Mailing Address - Country:US
Mailing Address - Phone:404-521-2445
Mailing Address - Fax:404-521-0067
Practice Address - Street 1:427 MORELAND AVE NE
Practice Address - Street 2:SUITE 400
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-1500
Practice Address - Country:US
Practice Address - Phone:404-521-2445
Practice Address - Fax:404-521-0067
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-16
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
GA229562080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAC76817Medicare UPIN