Provider Demographics
NPI:1528148400
Name:ISENSTEIN, DOUGLAS ANDREW (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ANDREW
Last Name:ISENSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 TREE LANE ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078
Mailing Address - Country:US
Mailing Address - Phone:770-979-0367
Mailing Address - Fax:770-979-1830
Practice Address - Street 1:1800 TREE LANE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078
Practice Address - Country:US
Practice Address - Phone:770-979-0367
Practice Address - Fax:770-979-1830
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025770207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0032622Medicaid
GACD7170OtherRAILROAD MEDICARE
GAGRP2664OtherGROUP MEDICARE #
D29846Medicare UPIN
GA0032622Medicaid