Healthcare Provider Details

I. General information

NPI: 1043838501
Provider Name (Legal Business Name): MARINE ISAKADZE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 HOSPITAL DR STE 303
LAFAYETTE LA
70503-2852
US

IV. Provider business mailing address

155 HOSPITAL DR STE 303
LAFAYETTE LA
70503-2852
US

V. Phone/Fax

Practice location:
  • Phone: 337-571-2917
  • Fax:
Mailing address:
  • Phone: 404-910-9661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number352381
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: