1093765067 NPI number — MR. DAVID N ISAAC FNP-C

Table of content: MR. DAVID N ISAAC FNP-C (NPI 1093765067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093765067 NPI number — MR. DAVID N ISAAC FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ISAAC
Provider First Name:
DAVID
Provider Middle Name:
N
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093765067
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
235 PEACHTREE ST NE
Provider Second Line Business Mailing Address:
NORTH TOWER, SUITE 2100
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30303-1401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-994-9326
Provider Business Mailing Address Fax Number:
770-994-4747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 UPPER RIVERDALE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERDALE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30274-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-991-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN136301 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: RN 136301 NP , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 589185903I , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01190343 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 589185903G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 589185903H , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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