Basic Information
| Provider Information | |||||||||
| NPI: | 1205154069 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IVIE | ||||||||
| FirstName: | ABIGAIL | ||||||||
| MiddleName: | DAHL | ||||||||
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| Credential: | CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1185L DAVIS PL NW | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303187515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4046002909 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5455 MERIDIAN MARKS RD NE | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042552033 | ||||||||
| FaxNumber: | 4042521901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2010 | ||||||||
| LastUpdateDate: | 07/15/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | RN188532 NP | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.