Healthcare Provider Details

I. General information

NPI: 1437714870
Provider Name (Legal Business Name): MARILYN ABRAHAM PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 GA HIGHWAY 127
KATHLEEN GA
31047-2828
US

IV. Provider business mailing address

3708 NORTHSIDE DR
MACON GA
31210-2404
US

V. Phone/Fax

Practice location:
  • Phone: 478-971-1153
  • Fax: 478-971-1171
Mailing address:
  • Phone: 478-745-4206
  • Fax: 478-254-5463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016982
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: