MEDICARE: KAREN DOMITILA ZAVALA-ABREGO

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	390200000X	Student in an Organized Health Care Education/Training Program
2	163WM0102X	Maternal Newborn Registered Nurse	300402	GA

General Provider Information

NPI Number	:	1669272019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN DOMITILA ZAVALA-ABREGO

Provider Business Mailing Address
First Line	:	PO BOX 742616
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-2616
Country	:	US
Telephone Number	:	770-219-8420
Fax Number	:

Provider Business Practice Location Address
First Line	:	1315 JESSE JEWELL PKWY NE STE 200
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-3821
Country	:	US
Telephone Number	:	770-219-9300
Fax Number	:

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

Provider Enumeration Date	:	03/14/2025
Last Update Date	:	07/21/2025

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