Healthcare Provider Details

I. General information

NPI: 1477537322
Provider Name (Legal Business Name): ABIGAIL KAMISHLIAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 08/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4905 COURTNEY DR
FOREST PARK GA
30297-1427
US

IV. Provider business mailing address

4905 COURTNEY DR
FOREST PARK GA
30297-1427
US

V. Phone/Fax

Practice location:
  • Phone: 404-366-3636
  • Fax: 404-362-0808
Mailing address:
  • Phone: 404-366-3636
  • Fax: 404-362-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number044580
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: