Healthcare Provider Details

I. General information

NPI: 1538489893
Provider Name (Legal Business Name): KAMRAN ABOLMAALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL CENTER DR 2500
HUNTINGTON WV
25701-3656
US

IV. Provider business mailing address

11975 MORRIS RD STE 220
ALPHARETTA GA
30005-4444
US

V. Phone/Fax

Practice location:
  • Phone: 304-691-1200
  • Fax: 304-691-1209
Mailing address:
  • Phone: 404-781-9094
  • Fax: 770-733-1511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number80255
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number80255
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: