Individual provider Active NPI

Lydia Kaoutzani, MD

  • Neurological Surgery Physician
  • Rome, GA
National Provider Identifier
1508387499
Registry record updated Jun 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
103234 Issued in GA
Practice address
15 John Maddox Dr NW
Rome, GA 30165-1413
Phone
(706) 368-8550
Fax
(706) 236-7473
NPI assigned
Jun 29, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 103234 GA Primary
Surgery Physician 208600000X 272276 MA

Addresses

Primary practice location

15 John Maddox Dr NW
Rome, GA 30165-1413

Mailing address

PO Box 12938
C/O Clinic Management
Calhoun, GA 30703
Phone (706) 602-7800

Other practice location 1

1120 15th St
Augusta, GA 30912-0004
Phone (706) 721-7124

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250515002796 GA Practitioner - Neurosurgery 4183998040 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians
Adventist Health System Georgia IncGroup PAC ID 4486568037, 247 clinicians

Practice addresses (Care Compare)

1120 15TH St
Augusta, GA 30912-0004
Phone (706) 721-8623

15 John Maddox Dr NW
Rome, GA 30165-1413
Phone (706) 368-8550

5150 Stilesboro N W Rd
Suite 220
Kennesaw, GA 30152-7742
Phone (770) 424-8222

989 Saint Sebastian Way
Augusta, GA 30912-0004
Phone (706) 721-2171

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
103234GAMDNeurological Surgery Physician
272276MAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince May 1, 2025 Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients

Locations

1120 15th St
#2029
Augusta, GA 30912

1120 15th St
Augusta, GA 30912
Phone (706) 721-3873

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1498694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782691200000",
    "number": "1508387499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12938",
            "address_2": "C/O CLINIC MANAGEMENT",
            "city": "CALHOUN",
            "state": "GA",
            "postal_code": "30703",
            "telephone_number": "706-602-7800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 JOHN MADDOX DR NW",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301651413",
            "telephone_number": "706-368-8550",
            "fax_number": "706-236-7473"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1120 15th St",
            "address_purpose": "LOCATION",
            "city": "Augusta",
            "state": "GA",
            "postal_code": "309120004",
            "country_code": "US",
            "telephone_number": "706-721-7124",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KAOUTZANI",
        "first_name": "LYDIA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-29",
        "last_updated": "2026-06-29",
        "certification_date": "2026-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "GA",
            "license": "103234",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MA",
            "license": "272276",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rome, GA

Sources for this page

Verify at the official NPI Registry.