Healthcare Provider Details

I. General information

NPI: 1427115864
Provider Name (Legal Business Name): NOEL RAYMUND ISRAEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 FORSYTH ST STE 2E
MACON GA
31201-8631
US

IV. Provider business mailing address

1062 FORSYTH ST STE 2E
MACON GA
31201-8631
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-7330
  • Fax: 478-633-7360
Mailing address:
  • Phone: 478-633-7330
  • Fax: 478-633-7360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number035911
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: