Provider Demographics
NPI:1093765067
Name:ISAAC, DAVID N (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:N
Last Name:ISAAC
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 PEACHTREE ST NE
Mailing Address - Street 2:NORTH TOWER, SUITE 2100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-1401
Mailing Address - Country:US
Mailing Address - Phone:770-994-9326
Mailing Address - Fax:770-994-4747
Practice Address - Street 1:11 UPPER RIVERDALE RD
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-0000
Practice Address - Country:US
Practice Address - Phone:770-991-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN136301163W00000X
GARN 136301 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA589185903IMedicaid
GA01190343OtherAMERIGROUP
GA589185903GMedicaid
GA589185903HMedicaid
GA589185903HMedicaid
GA511I500377Medicare PIN
GA50BBKBCMedicare ID - Type Unspecified