Vassilakis Vassiliou, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

004684 Issued in GA

Practice address

460 Northside Cherokee Blvd Ste 130
Canton, GA 30115-8017

Phone

(678) 493-2527

Fax

(678) 593-5608

NPI assigned

Sep 27, 2006

Last updated

Jan 5, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northside Primary Care Professional Services,LLC

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1922397553
  NPD (past)
• Pinnacle Orthopaedics & Sports Medicine Specialists LLC

  • Orthopaedic Surgery Physician
  • Marietta, GA
  • NPI 1013059823
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515110400000",
    "number": "1295826105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 WHITCHER STREET",
            "address_2": "SUITE 350",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601129",
            "telephone_number": "770-424-6893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 NORTHSIDE CHEROKEE BLVD STE 130",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301158017",
            "telephone_number": "678-493-2527",
            "fax_number": "678-593-5608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VASSILIOU",
        "first_name": "VASSILAKIS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2018-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "004684",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000456211C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000456211F",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000456211G",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000456211D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000456211E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Akhil Vallabhaneni, MD
• Samantha Van Sickle, LPC
• Ronald A Van Tuyl Jr., MD
• Kristen Grace Van Waters, FNP-BC
• April Roxanne Vanis
• Jamie Vecsey, LPC
• Veinte Veinte Onsight Optometry PC (2020 Onsight O.D.)
• Kimberly E Vernachio, PHARMD
• Sheryl B Vickery, M.D.
• Village Podiatry Group, LLC.

• Physician Assistant in Canton, GA
• Providers in Canton, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.