Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 056720 | GA |
Y | 111NI0900X | Internist | 056720 | GA |
N | 207RP1001X | Pulmonary Disease | 056720 | GA |
N | 207RS0012X | Sleep Medicine | 056720 | GA |
NPI | 1053305888 |
---|---|
Provider Name | Dr. Elias Georges Issa |
First Address | Blue Ridge, GA 30513-3240 |
Second Address | Blue Ridge, GA 30513-6648 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2005 |
Last Update Date | 29/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4047230 | (05) | TN |
4047231 | (05) | TN |
5905148 | (05) | NC |
714558090A | (05) | GA |
714558090B | (05) | GA |
714558090C | (05) | GA |
714558090D | (05) | GA |
714558090G | (05) | GA |