| Doctor Name: | NICHOLAS PAUL GEORGELOS |
| NPI Number: | 1518378629 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | SL1011 |
| Business Practice Address: | 3520 Wheeler St Apt 1325 Dallas, TX - 752096401 |
| Business Phone Number: | 6309139072 |
| Business Fax Number: | 6309139072 |
| Mailing Address: | 3520 Wheeler St, Apt 1325 DALLAS |
| State: | TX |
| Postal Code: | 752096401 |
| Phone Number: | 6309139072 |
| Fax Number: | 6309139072 |
| NPI Enumeration Date: | 05/12/2014 |
| NPI Last Update Date: | 06/18/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | SL1011 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NV |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |