Provider Demographics
NPI:1568700334
Name:IZADI, MONA (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MONA
Middle Name:
Last Name:IZADI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10152 BLUE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-5935
Mailing Address - Country:US
Mailing Address - Phone:706-946-3621
Mailing Address - Fax:706-946-3622
Practice Address - Street 1:10152 BLUE RIDGE DR
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-5935
Practice Address - Country:US
Practice Address - Phone:706-946-3621
Practice Address - Fax:706-946-3622
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN079353363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily