Provider Demographics
NPI:1245643105
Name:ISKHAKOV, ALEKSANDR
Entity type:Individual
Prefix:
First Name:ALEKSANDR
Middle Name:
Last Name:ISKHAKOV
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:ISKHAKOV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1405 ELM CREEK LN
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-2708
Mailing Address - Country:US
Mailing Address - Phone:404-695-5817
Mailing Address - Fax:
Practice Address - Street 1:235 PEACHTREE ST NE STE 2100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-1405
Practice Address - Country:US
Practice Address - Phone:770-994-9326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007195363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant