Provider Demographics
NPI:1720747314
Name:ISAACS, DEANNA FAITH
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:FAITH
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 1:1234 BELLAIRE DR NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3330
Mailing Address - Country:US
Mailing Address - Phone:828-606-9435
Mailing Address - Fax:
Practice Address - Street 1:229 PEACHTREE HILLS AVENUE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305
Practice Address - Country:US
Practice Address - Phone:404-467-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-11
Last Update Date:2021-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA002532225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Single Specialty