Healthcare Provider Details

I. General information

NPI: 1871703033
Provider Name (Legal Business Name): ISATA CELIA MOMOH NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 ADAMS POINTE DR
SNELLVILLE GA
30078-2930
US

IV. Provider business mailing address

2675 N DECATUR RD 410
DECATUR GA
30033-6131
US

V. Phone/Fax

Practice location:
  • Phone: 770-978-5032
  • Fax:
Mailing address:
  • Phone: 404-501-2927
  • Fax: 404-501-7644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP136010
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN136010
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: