MEDICARE: DR. ABIGAIL ATKINS EDD

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	103T00000X	Psychologist	PSY 3643	AZ
2	103TC0700X	Clinical Psychologist	PSY 9691	CA

General Provider Information

NPI Number	:	1609957315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ABIGAIL ATKINS EDD

Provider Business Mailing Address
First Line	:	20280 N 59TH AVE STE 115-620
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-6850
Country	:	US
Telephone Number	:	602-870-3162
Fax Number	:

Provider Business Practice Location Address
First Line	:	20280 N 59TH AVE STE 115-620
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-6850
Country	:	US
Telephone Number	:	602-870-3162
Fax Number	:

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	04/05/2022

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