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General NPI Number Information
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NPI Number | 1649054008
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Entity Type | Individual
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Provider Name | ISAURA CABRERA
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Gender | Female
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Dates
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Enumeration Date | 08/24/2023
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Last Update Date | 08/24/2023
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Provider Practice Location Address
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Address Line | 3333 JODECO RD STE A
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City | MCDONOUGH
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State | GA
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Zip | 30253-5371
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Country | US
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Telephone | 770-692-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 159 WILLOW SPRINGS LN
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-6241
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Country | US
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Telephone | 678-914-3118
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN301544
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License Number State | GA
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