Provider Demographics
NPI:1518038660
Name:ISANG, MERCY EMMANUEL (MD)
Entity Type:Individual
Prefix:
First Name:MERCY
Middle Name:EMMANUEL
Last Name:ISANG
Suffix:
Gender:F
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:PO BOX 405674
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5674
Mailing Address - Country:US
Mailing Address - Phone:931-879-6293
Mailing Address - Fax:931-879-9007
Practice Address - Street 1:114 N DUNCAN ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556-3100
Practice Address - Country:US
Practice Address - Phone:931-879-6293
Practice Address - Fax:931-879-9007
Is Sole Proprietor?:No
Enumeration Date:2006-11-12
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN365332084P0800X
GA0505282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4082484OtherBLUE CROSS PROVIDER #
TN4082484OtherBLUE CROSS PROVIDER #
TNH53185Medicare UPIN