Healthcare Provider Details

I. General information

NPI: 1427236413
Provider Name (Legal Business Name): INESSA FISHMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 03/07/2023
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 JOHNSON FY RD NE STE 470
ATLANTA GA
30342-5031
US

IV. Provider business mailing address

1100 JOHNSON FY RD NE STE 470
ATLANTA GA
30342-5031
US

V. Phone/Fax

Practice location:
  • Phone: 678-974-8435
  • Fax: 678-974-8476
Mailing address:
  • Phone: 678-974-8435
  • Fax: 678-974-8476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD.32089
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberMD.32089
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberMD.70105
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: