Basic Information
| Provider Information | |||||||||
| NPI: | 1093765067 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ISAAC | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 235 PEACHTREE ST NE | ||||||||
| Address2: | NORTH TOWER, SUITE 2100 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303031401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709949326 | ||||||||
| FaxNumber: | 7709944747 | ||||||||
| Practice Location | |||||||||
| Address1: | 11 UPPER RIVERDALE RD | ||||||||
| Address2: | |||||||||
| City: | RIVERDALE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302740000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709918000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 08/06/2008 | ||||||||
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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 | 163W00000X | RN136301 | GA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | RN 136301 NP | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 589185903I | 05 | GA | MEDICAID | 01190343 | 01 | GA | AMERIGROUP | OTHER | 589185903G | 05 | GA | MEDICAID | 589185903H | 05 | GA | MEDICAID |