Provider Demographics
NPI:1093219958
Name:ISOA, CYNTHIA
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:ISOA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VIRTUE
Other - Middle Name:CYNTHIA-ISOA
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNA, PCT
Mailing Address - Street 1:PO BOX 491002
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-0087
Mailing Address - Country:US
Mailing Address - Phone:770-334-7308
Mailing Address - Fax:762-583-8044
Practice Address - Street 1:768 BENDER ST SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-2112
Practice Address - Country:US
Practice Address - Phone:770-334-7308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0030000228376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty