Individual provider Active NPI

Abegail Tate Dismukes

  • Physician Assistant
  • Atlanta, GA
National Provider Identifier
1861074338
Registry record updated Sep 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10579 Issued in GA
Practice address
5665 New Northside Dr Ste 320
Atlanta, GA 30328-5834
Phone
(770) 874-5400
NPI assigned
Apr 24, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 10579 GA Primary

Addresses

Primary practice location

5665 New Northside Dr Ste 320
Atlanta, GA 30328-5834

Mailing address

102 Orchard Cir
Dothan, AL 36305-5814
Phone (334) 797-3774

Other practice location 1

625 Old Peachtree Rd NW
Suwanee, GA 30024-2937
Phone (678) 225-7500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210921003251 GA Practitioner - Physician Assistant 8123425931 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellstreet of Georgia PCGroup PAC ID 7517126279, 425 clinicians

Practice addresses (Care Compare)

1155 Concord Rd SE
Suite 200
Smyrna, GA 30080-4255
Phone (678) 600-5137

1280 Dogwood Dr SE
Conyers, GA 30013-5046
Phone (404) 994-4662

2292 Peachtree Rd
Atlanta, GA 30309-1147
Phone (404) 382-9941

2520 N Decatur Rd
Decatur, GA 30033-6117
Phone (678) 685-8100

2810 Paces Ferry Rd SE
Suite 156
Atlanta, GA 30339-5700
Phone (470) 750-1301

3617 Roswell Nerd a
Atlanta, GA 30305-1111
Phone (404) 996-0196

500 Nathan Dean Blvd
Suite 105
Dallas, GA 30157-4911
Phone (470) 624-6793

Merit-based Incentive Payment System (MIPS)

Final score
91.62 of 100Reported as apm
Quality
83.25
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
First Class Healthcare LLC PastSince Sep 20, 2022 Accepting new patients

Organizations & group practices 3

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": "1619222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630972800000",
    "number": "1861074338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 ORCHARD CIR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363055814",
            "telephone_number": "334-797-3774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5665 NEW NORTHSIDE DR STE 320",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303285834",
            "telephone_number": "770-874-5400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "625 Old Peachtree Rd NW",
            "address_purpose": "LOCATION",
            "city": "Suwanee",
            "state": "GA",
            "postal_code": "300242937",
            "country_code": "US",
            "telephone_number": "678-225-7500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DISMUKES",
        "first_name": "ABEGAIL",
        "middle_name": "TATE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-24",
        "last_updated": "2021-09-07",
        "certification_date": "2021-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "10579",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.