Betty V Koukis, PC
Organization Active NPI Gynecology Physician · Moultrie, GA
NPI 1417470360 · NPPES record last updated Mar 10, 2020
Key facts
- NPI
- 1417470360
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Gynecology Physician 207VG0400X
- Legal business name
- BETTY V KOUKIS, PC
- Practice address
- 1405 S Main St
Moultrie, GA 31768-5811 - Phone
- (229) 785-2335
- NPI assigned
- Jul 24, 2017
- Organization subpart
- No
Authorized official
- Name
- Betty Vassiliki Koukis
- Title
- MD
- Phone
- (229) 785-2335
Practitioners 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170807001995 | GA | Part B Supplier - Clinic/Group Practice | 2961773163 |
Receives reassigned benefits from 2 practitioners Practice locations: Moultrie, GA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gynecology Physician |
207VG0400X | GA | Yes |
Addresses
Primary practice location
1405 S Main St
Moultrie, GA 31768-5811
Mailing address
30 Oak LN
Moultrie, GA 31768-5444
Phone (917) 386-5611
Other providers in Moultrie, GA
- Anna Virginia Bennett
- Casey Jo Bennett
- Lila Leanne Bennett
- Brian Berl
- Seth Allen Berl
- Kevin Bhagratie
- Tara Jean Bittner
- Ashley Blalock
- Mark H Blanchard
- Amber Brooke Blease
All providers in Moultrie, GA · Gynecology Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 10, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.