Provider Demographics
NPI:1841876646
Name:ABBOT, DAVID KIMBALL
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:KIMBALL
Last Name:ABBOT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 W DOYLE ST
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-1791
Mailing Address - Country:US
Mailing Address - Phone:706-886-4673
Mailing Address - Fax:
Practice Address - Street 1:467 W DOYLE ST
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-1791
Practice Address - Country:US
Practice Address - Phone:706-886-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor