Basic Information
| Provider Information | |||||||||
| NPI: | 1487078606 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MISHAK | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 COLLIER RD NW | ||||||||
| Address2: | STE 4075 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4046033543 | ||||||||
| FaxNumber: | 4043508795 | ||||||||
| Practice Location | |||||||||
| Address1: | 659 AUBURN AVE NE | ||||||||
| Address2: | SUITE 156 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303125412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048880228 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2014 | ||||||||
| LastUpdateDate: | 04/12/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 007094 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.