Basic Information
| Provider Information | |||||||||
| NPI: | 1447828082 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEORGAKAS | ||||||||
| FirstName: | JOANNA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 345 BLACKSTONE BLVD STE 2 | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029064829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014556375 | ||||||||
| FaxNumber: | 4014556535 | ||||||||
| Practice Location | |||||||||
| Address1: | 345 BLACKSTONE BLVD BLDG E-160 | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029064800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014556375 | ||||||||
| FaxNumber: | 4014556545 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2021 | ||||||||
| LastUpdateDate: | 06/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | LP05294 | RI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.