Healthcare Provider Details

I. General information

NPI: 1306693395
Provider Name (Legal Business Name): TONY ABRAHAM SAJ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5127 JIMMY CARTER BLVD
NORCROSS GA
30093-1619
US

IV. Provider business mailing address

5127 JIMMY CARTER BLVD
NORCROSS GA
30093-1619
US

V. Phone/Fax

Practice location:
  • Phone: 860-992-6835
  • Fax:
Mailing address:
  • Phone: 860-992-6835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12194
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: