Healthcare Provider Details

I. General information

NPI: 1184733370
Provider Name (Legal Business Name): ED A. ABELL M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1296 SIMS ST STE B
GAINESVILLE GA
30501-3850
US

IV. Provider business mailing address

1296 SIMS ST STE B
GAINESVILLE GA
30501-3873
US

V. Phone/Fax

Practice location:
  • Phone: 770-534-1856
  • Fax:
Mailing address:
  • Phone: 770-534-1856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number054533
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: