Healthcare Provider Details

I. General information

NPI: 1154584555
Provider Name (Legal Business Name): KATHY C ISLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LOCKHEED MARTIN AERONAUTICS CO 86 SOUTH COBB DRIVE, DEPT RE2M, ZONE 0454
MARIETTA GA
30063-0001
US

IV. Provider business mailing address

LOCKHEED MARTIN AERONAUTICS CO 86 SOUTH COBB DRIVE, DEPT RE2M, ZONE 0454
MARIETTA GA
30063-0001
US

V. Phone/Fax

Practice location:
  • Phone: 770-494-1152
  • Fax: 770-494-5331
Mailing address:
  • Phone: 770-494-1152
  • Fax: 770-494-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: