Healthcare Provider Details

I. General information

NPI: 1124056627
Provider Name (Legal Business Name): CHRISTOPHER MUNRO ABBOT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 01/04/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 BURLEYSON RD SUITE 202
DALTON GA
30720-3094
US

IV. Provider business mailing address

1109 BURLEYSON RD SUITE 202
DALTON GA
30720-3094
US

V. Phone/Fax

Practice location:
  • Phone: 706-277-1573
  • Fax: 706-370-7715
Mailing address:
  • Phone: 706-277-1573
  • Fax: 706-370-7715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number058127
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: