Provider Demographics
NPI:1477537322
Name:KAMISHLIAN, ABIGAIL (MD)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:KAMISHLIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 COURTNEY DR
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-1427
Mailing Address - Country:US
Mailing Address - Phone:404-366-3636
Mailing Address - Fax:404-362-0808
Practice Address - Street 1:4905 COURTNEY DR
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-1427
Practice Address - Country:US
Practice Address - Phone:404-366-3636
Practice Address - Fax:404-362-0808
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044580208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000777741DMedicaid
GA305675OtherWELLCARE
GA58-1631879OtherTAX ID
GA966369OtherBLUE CROSS BLUE SHIELD
GA260699313OtherTAX ID
GA10038631OtherAMERIGROUP
GA000777741EMedicaid
GA000777741GMedicaid
GA000777741CMedicaid