Individual
DR. BETTY VASSILIKI KOUKIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
1405 S MAIN ST, MOULTRIE, GA 31768-5811
(229) 785-2335
(229) 785-2336
Mailing address
104 MEDICAL DR, DOTHAN, AL 36303-6902
(334) 671-9445
(334) 836-0059
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
066134
GA
207V00000X
Obstetrics & Gynecology Physician
4301090876
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003110693A
—
GA
Enumeration date
07/03/2007
Last updated
03/10/2020
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