Provider Demographics
NPI:1205154069
Name:IVIE, ABIGAIL DAHL (CPNP)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:DAHL
Last Name:IVIE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185L DAVIS PL NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-7515
Mailing Address - Country:US
Mailing Address - Phone:404-600-2909
Mailing Address - Fax:
Practice Address - Street 1:5455 MERIDIAN MARKS RD NE
Practice Address - Street 2:SUITE 130
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1654
Practice Address - Country:US
Practice Address - Phone:404-255-2033
Practice Address - Fax:404-252-1901
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN188532 NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics