Active NPI
Antonios Anagnostopoulos, DO
- Psychiatry Physician
- Fayetteville, NC
National Provider Identifier
1104445139
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 2022-02154
- Practice address
- 1638 Owen Drive
Fayetteville, NC 28304 - Phone
- (910) 615-5095
- NPI assigned
- Apr 9, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Psychiatry Physician | 2084P0800X | 2022-02154 | NC | Primary |
Addresses
Primary practice location
1638 Owen Drive
Fayetteville, NC 28304
Mailing address
1638 Owen Drive
Fayetteville, NC 28304
Phone (910) 615-5095
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 15, 2026 through Jun 15, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2022-02154 | NC | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1586390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670889600000",
"number": "1104445139",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1638 OWEN DRIVE",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "28304",
"telephone_number": "910-615-5095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1638 OWEN DRIVE",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "28304",
"telephone_number": "910-615-5095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANAGNOSTOPOULOS",
"first_name": "ANTONIOS",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-04-09",
"last_updated": "2022-12-13",
"certification_date": "2022-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NC",
"license": "2022-02154",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.