Provider Demographics
NPI:1093420614
Name:LUNDSTROM, ABBY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:
Last Name:LUNDSTROM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ABBY
Other - Middle Name:
Other - Last Name:SALMONSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-0370
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:394 HARDING PL STE 200
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-3980
Practice Address - Country:US
Practice Address - Phone:615-834-4482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5390363A00000X
TNPA5390363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant