Healthcare Provider Details

I. General information

NPI: 1881701936
Provider Name (Legal Business Name): ZIA A ABDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2386 BOLTON RD
ATLANTA GA
30318
US

IV. Provider business mailing address

2386 BOLTON RD
ATLANTA GA
30318
US

V. Phone/Fax

Practice location:
  • Phone: 404-352-2810
  • Fax: 404-605-0602
Mailing address:
  • Phone: 404-352-2810
  • Fax: 404-352-4457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number030705
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: