Individual
VASSILAKIS VASSILIOU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
460 NORTHSIDE CHEROKEE BLVD STE 130, CANTON, GA 30115-8017
(678) 493-2527
(678) 593-5608
Mailing address
55 WHITCHER STREET, SUITE 350, MARIETTA, GA 30060-1129
(770) 424-6893
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004684
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000456211C
—
GA
05
—
000456211D
—
GA
05
—
000456211E
—
GA
05
—
000456211F
—
GA
05
—
000456211G
—
GA
Enumeration date
09/27/2006
Last updated
01/05/2018
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