Healthcare Provider Details

I. General information

NPI: 1093765067
Provider Name (Legal Business Name): DAVID N ISAAC FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 UPPER RIVERDALE RD
RIVERDALE GA
30274-0000
US

IV. Provider business mailing address

235 PEACHTREE ST NE NORTH TOWER, SUITE 2100
ATLANTA GA
30303-1401
US

V. Phone/Fax

Practice location:
  • Phone: 770-991-8000
  • Fax:
Mailing address:
  • Phone: 770-994-9326
  • Fax: 770-994-4747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN136301
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN 136301 NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: