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General NPI Number Information
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NPI Number | 1497227797
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Entity Type | Individual
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Provider Name | MUSTAPHA TIMMY ISSA CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/26/2018
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 470 DACULA RD UNIT 145
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City | DACULA
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State | GA
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Zip | 30019-0102
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Country | US
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Telephone | 954-547-9602
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Fax |
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Provider Business Mailing Address
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Address Line | 470 DACULA RD UNIT 145
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City | DACULA
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State | GA
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Zip | 30019-0102
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Country | US
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Telephone | 954-547-9602
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 24769
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 214261
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License Number State | GA
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