Provider Demographics
NPI:1477100337
Name:ISAACS, GLENDA C
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:C
Last Name:ISAACS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MEADOWRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-1217
Mailing Address - Country:US
Mailing Address - Phone:678-665-2905
Mailing Address - Fax:
Practice Address - Street 1:100 MEADOWRIDGE DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-1217
Practice Address - Country:US
Practice Address - Phone:678-665-2905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management