MEDICARE: CHRISTOPHER LEE MISHAK PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	007094	GA

General Provider Information

NPI Number	:	1487078606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER LEE MISHAK PA

Provider Business Mailing Address
First Line	:	95 COLLIER RD NW
Second Line	:	STE 4075
City	:	ATLANTA
State	:	GA
Zip	:	30309-1751
Country	:	US
Telephone Number	:	404-603-3543
Fax Number	:	404-350-8795

Provider Business Practice Location Address
First Line	:	659 AUBURN AVE NE
Second Line	:	SUITE 156
City	:	ATLANTA
State	:	GA
Zip	:	30312-5412
Country	:	US
Telephone Number	:	404-888-0228
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2014
Last Update Date	:	04/12/2016

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