Individual
MARY ABRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
350 WINN WAY, DECATUR, GA 30030-2106
(404) 508-1177
(404) 508-9640
Mailing address
350 WINN WAY, DECATUR, GA 30030-2106
(404) 508-1177
(404) 508-9640
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
056399
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10045386
AMERIGROUP
GA
05
—
236258795A
—
GA
05
—
236258795B
—
GA
05
—
236258795C
—
GA
05
—
236258795D
—
GA
01
—
2625722
UHC
GA
01
—
2947741
CIGNA
GA
01
—
335588
WELLCARE
GA
01
—
335852
WELLCARE
GA
01
—
335853
WELLCARE
GA
01
—
335854
WELLCARE
GA
01
—
52704327
BCBS
GA
01
—
7673845
AETNA
GA
Enumeration date
08/09/2006
Last updated
07/23/2007
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