Basic Information
| Provider Information | |||||||||
| NPI: | 1497410344 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ISAAC-SOBERANIS | ||||||||
| FirstName: | SHEENA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11022 SOUTHWOOD DR | ||||||||
| Address2: | |||||||||
| City: | HAMPTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302285301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043868789 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2665 N DECATUR RD STE 330 | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300336145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042979755 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2021 | ||||||||
| LastUpdateDate: | 11/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1744R1102X | Y | Other Service Providers | Specialist | Research Study |
No ID Information.