Provider Demographics
NPI:1912054289
Name:NUCHPRAYOON, ISSARANG (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:ISSARANG
Middle Name:
Last Name:NUCHPRAYOON
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:DR
Other - First Name:ISSARANG
Other - Middle Name:PORN
Other - Last Name:NUCHPRAYOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD PHD
Mailing Address - Street 1:216 ARROWHEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-1102
Mailing Address - Country:US
Mailing Address - Phone:678-852-6490
Mailing Address - Fax:
Practice Address - Street 1:216 ARROWHEAD BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1102
Practice Address - Country:US
Practice Address - Phone:678-852-6490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2009-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD42535208000000X
MI4301053965208000000X
GA59101208000000X
WAMD00047463208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAF34985Medicare UPIN