Provider Demographics
NPI:1558672782
Name:RICKETTS, ISABELLA ZITA (MD)
Entity Type:Individual
Prefix:DR
First Name:ISABELLA
Middle Name:ZITA
Last Name:RICKETTS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1300 RIDENOUR BLVD NW
Mailing Address - Street 2:MAK ANESTHESIA
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4501
Mailing Address - Country:US
Mailing Address - Phone:770-702-1806
Mailing Address - Fax:770-693-0810
Practice Address - Street 1:1300 RIDENOUR BLVD NW
Practice Address - Street 2:MAK ANESTHESIA
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4501
Practice Address - Country:US
Practice Address - Phone:770-702-1806
Practice Address - Fax:770-693-0810
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2018-10-24
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Provider Licenses
StateLicense IDTaxonomies
GA77276207L00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology