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General NPI Number Information
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NPI Number | 1902079544
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Entity Type | Organization
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Legal Business Name | GEORGE ISSHAK,LLC
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Dates
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Enumeration Date | 04/03/2008
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Last Update Date | 04/03/2008
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Provider Practice Location Address
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Address Line | 1215 VINEYARD DR SE
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City | CONYERS
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State | GA
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Zip | 30013-2467
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Country | US
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Telephone | 770-653-9033
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Fax |
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Provider Business Mailing Address
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Address Line | 1215 VINEYARD DR SE
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City | CONYERS
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State | GA
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Zip | 30013-2467
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Country | US
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Telephone | 770-653-9033
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING MANAGER
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Name | DR. GEORGE ISSHAK
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Credential | M.D.
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Telephone | 770-653-9033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 023369
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License Number State | GA
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