Provider Demographics
NPI:1487078606
Name:MISHAK, CHRISTOPHER LEE (PA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LEE
Last Name:MISHAK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:95 COLLIER RD NW
Mailing Address - Street 2:STE 4075
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1751
Mailing Address - Country:US
Mailing Address - Phone:404-603-3543
Mailing Address - Fax:404-350-8795
Practice Address - Street 1:659 AUBURN AVE NE
Practice Address - Street 2:SUITE 156
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-5412
Practice Address - Country:US
Practice Address - Phone:404-888-0228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2016-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA007094363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical