Provider Demographics
NPI:1669272019
Name:ZAVALA-ABREGO, KAREN DOMITILA
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:DOMITILA
Last Name:ZAVALA-ABREGO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 PLUM FROST CT
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-2420
Mailing Address - Country:US
Mailing Address - Phone:678-316-4751
Mailing Address - Fax:
Practice Address - Street 1:1315 JESSE JEWELL PKWY NE STE 201
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3811
Practice Address - Country:US
Practice Address - Phone:770-219-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA300402163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program