Provider Demographics
NPI:1205364882
Name:FIELDS, ABBOTT ELLISON (MD)
Entity Type:Individual
Prefix:
First Name:ABBOTT
Middle Name:ELLISON
Last Name:FIELDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ABBEY
Other - Middle Name:ELLISON
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:140 ALLEN COURT
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29860
Mailing Address - Country:US
Mailing Address - Phone:803-510-0007
Mailing Address - Fax:803-510-0144
Practice Address - Street 1:140 ALLEN COURT
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29860
Practice Address - Country:US
Practice Address - Phone:803-510-0007
Practice Address - Fax:803-510-0144
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009023208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics