Provider Demographics
NPI:1073747655
Name:ISOM, REBEKAH (ANP-BC)
Entity Type:Individual
Prefix:MS
First Name:REBEKAH
Middle Name:
Last Name:ISOM
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5775-B GLENRIDGE DRIVE
Mailing Address - Street 2:SUITE 145
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5775 GLENRIDGE DR NE # B
Practice Address - Street 2:SUITE 145
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5380
Practice Address - Country:US
Practice Address - Phone:404-501-1849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN162611 NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health