Individual
ABIGAIL KAMISHLIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4905 COURTNEY DR, FOREST PARK, GA 30297-1427
(404) 366-3636
(404) 362-0808
Mailing address
4905 COURTNEY DR, FOREST PARK, GA 30297-1427
(404) 366-3636
(404) 362-0808
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
044580
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000777741C
—
GA
05
—
000777741D
—
GA
05
—
000777741E
—
GA
05
—
000777741G
—
GA
01
—
10038631
AMERIGROUP
GA
01
—
260699313
TAX ID
GA
01
—
305675
WELLCARE
GA
01
—
58-1631879
TAX ID
GA
01
—
966369
BLUE CROSS BLUE SHIELD
GA
Enumeration date
12/05/2005
Last updated
08/30/2013
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