Provider Demographics
NPI:1831854504
Name:ABRAHA, FEVEN FISSHAYE (SA)
Entity type:Individual
Prefix:
First Name:FEVEN
Middle Name:FISSHAYE
Last Name:ABRAHA
Suffix:
Gender:F
Credentials:SA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6178 WINTERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-3744
Mailing Address - Country:US
Mailing Address - Phone:470-651-0935
Mailing Address - Fax:
Practice Address - Street 1:6178 WINTERGREEN RD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3744
Practice Address - Country:US
Practice Address - Phone:470-651-0935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-07
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant