Healthcare Provider Details

I. General information

NPI: 1770128266
Provider Name (Legal Business Name): ABIGAIL SCANLAN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2019
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 CENTURY BLVD NE STE 150
ATLANTA GA
30345-3323
US

IV. Provider business mailing address

1875 CENTURY BLVD NE STE 150
ATLANTA GA
30345-3323
US

V. Phone/Fax

Practice location:
  • Phone: 404-633-4595
  • Fax:
Mailing address:
  • Phone: 404-633-4595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN-NP290165
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN-NP290165
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: