NPIMap

Individual provider Active NPI

Abigail Kamishlian, M.D.

  • Pediatrics Physician
  • Forest Park, GA
National Provider Identifier
1477537322
Registry record updated Aug 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
044580 Issued in GA
Practice address
4905 Courtney Dr
Forest Park, GA 30297-1427
Phone
(404) 366-3636
Fax
(404) 362-0808
NPI assigned
Dec 5, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 044580 GA Primary

Addresses

Primary practice location

4905 Courtney Dr
Forest Park, GA 30297-1427

Mailing address

4905 Courtney Dr
Forest Park, GA 30297-1427
Phone (404) 366-3636

Other identifiers 9

IdentifierTypeStateIssuer
000777741DMedicaidGA
305675OtherGAWELLCARE
58-1631879OtherGATAX ID
966369OtherGABLUE CROSS BLUE SHIELD
260699313OtherGATAX ID
10038631OtherGAAMERIGROUP
000777741EMedicaidGA
000777741GMedicaidGA
000777741CMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
044580GAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Daffodil Pediatrics and Family Medicine Pediatrics Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: abigail.kamishlian@daffodilpeds.gadirect.net

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377820800000",
    "number": "1477537322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4905 COURTNEY DR",
            "city": "FOREST PARK",
            "state": "GA",
            "postal_code": "302971427",
            "telephone_number": "404-366-3636",
            "fax_number": "404-362-0808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4905 COURTNEY DR",
            "city": "FOREST PARK",
            "state": "GA",
            "postal_code": "302971427",
            "telephone_number": "404-366-3636",
            "fax_number": "404-362-0808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAMISHLIAN",
        "first_name": "ABIGAIL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-05",
        "last_updated": "2013-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "044580",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000777741D",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "305675",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "58-1631879",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "966369",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "260699313",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "10038631",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000777741E",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000777741G",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000777741C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Park, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.