Provider Demographics
NPI:1578539557
Name:CHAMSUDDIN, ABBAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:ABBAS
Middle Name:A
Last Name:CHAMSUDDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1501 CLAIRMONT RD
Mailing Address - Street 2:APT. 1731
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033
Mailing Address - Country:US
Mailing Address - Phone:888-886-5238
Mailing Address - Fax:888-886-9330
Practice Address - Street 1:1501 CLAIRMONT RD
Practice Address - Street 2:APT 1731
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4601
Practice Address - Country:US
Practice Address - Phone:952-595-1100
Practice Address - Fax:612-294-4903
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0510282085R0202X
NJ25MA068470002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000749207FMedicaid