Healthcare Provider Details

I. General information

NPI: 1023220316
Provider Name (Legal Business Name): TERAH C ISAACSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 W 4TH ST STE 102
COOKEVILLE TN
38501-2476
US

IV. Provider business mailing address

140 W 7TH ST
COOKEVILLE TN
38501-1726
US

V. Phone/Fax

Practice location:
  • Phone: 931-783-5515
  • Fax: 931-783-5513
Mailing address:
  • Phone: 931-783-5582
  • Fax: 931-526-6760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number61228
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberP4580
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberP4580
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number04-42832
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: