Healthcare Provider Details

I. General information

NPI: 1205740768
Provider Name (Legal Business Name): WISAM RAJAB ABUMRAD DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 PROFESSIONAL CT SW
ROME GA
30165-2832
US

IV. Provider business mailing address

880 W PEACHTREE ST NW UNIT 1718
ATLANTA GA
30309-2546
US

V. Phone/Fax

Practice location:
  • Phone: 706-388-3888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR011336
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: