Provider Demographics
NPI:1174904106
Name:ABAZERI, NATALIA (PA-C)
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:ABAZERI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 BOULEVARD NE STE 610
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-4212
Mailing Address - Country:US
Mailing Address - Phone:404-653-0039
Mailing Address - Fax:404-653-0159
Practice Address - Street 1:1050 EAGLES LANDING PKWY STE 302
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9250
Practice Address - Country:US
Practice Address - Phone:770-507-0070
Practice Address - Fax:770-507-7463
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7592363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1174904106OtherNPI
GA1407869407OtherPRACTICE NPI
GA7592OtherSTATE LICENSE
GAMA3666015OtherDEA