Provider Demographics
NPI:1730455759
Name:JALLOH, ISATU (PA)
Entity type:Individual
Prefix:
First Name:ISATU
Middle Name:
Last Name:JALLOH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:400 W PEACHTREE ST NW
Mailing Address - Street 2:UNIT 3403
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-3536
Mailing Address - Country:US
Mailing Address - Phone:347-522-6521
Mailing Address - Fax:
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:DAVIS FISCHER BUILDING- OFFICE 3304
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308
Practice Address - Country:US
Practice Address - Phone:404-686-7858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA006609363A00000X
NY015436363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant