Provider Demographics
NPI:1053305888
Name:ISSA, ELIAS GEORGES (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:GEORGES
Last Name:ISSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4799 BLUE RIDGE DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-3240
Mailing Address - Country:US
Mailing Address - Phone:706-946-4210
Mailing Address - Fax:
Practice Address - Street 1:101 RIVERSTONE VIS
Practice Address - Street 2:SUITE 207
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-6648
Practice Address - Country:US
Practice Address - Phone:706-964-4210
Practice Address - Fax:706-964-4251
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056720207R00000X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA714558090BMedicaid
NC5905148Medicaid
GA714558090AMedicaid
GA714558090CMedicaid
GA714558090DMedicaid
GA714558090GMedicaid
TN4047230Medicaid
TN4047231Medicaid