Mariam K. Ishaq, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

12436 Issued in GA

Practice address

470 Northside Cherokee Blvd Ste 480
Canton, GA 30115-8034

Phone

(404) 845-8200

NPI assigned

Dec 9, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Mercer University School of Medicine, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northside Cardiovascular Professional Services, LLCGroup PAC ID 9739189838, 143 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northside Hospital Cherokee Hospital, Canton, GA, CCN 110008
• Blue Ridge Medical Center Hospital, Blue Ridge, GA, CCN 111338

Medicare enrollment (NPD)

Enrolled

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northside Cardiovascular Professional Services, LLC

  • Cardiovascular Disease Physician
  • Roswell, GA
  • NPI 1518979921
  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Blue Ridge Georgia Hospital Company LLC

  dba Blue Ridge Medical Center

  • Critical Access Hospital
  • Blue Ridge, GA
  • NPI 1851362263
  Care Compare affiliation
• Northside Hospital, Inc.

  dba Northside Hospital Cherokee

  • General Acute Care Hospital
  • Canton, GA
  • NPI 1225050396
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1733702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740873600000",
    "number": "1639985245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "470 NORTHSIDE CHEROKEE BLVD STE 480",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301158034",
            "telephone_number": "404-845-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "470 NORTHSIDE CHEROKEE BLVD STE 480",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301158034",
            "telephone_number": "404-845-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISHAQ",
        "first_name": "MARIAM",
        "middle_name": "K.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-09",
        "last_updated": "2025-03-02",
        "certification_date": "2025-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "12436",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Louise Iraci, DC
• James S Irwin
• Stacy Irwin, MED. CCC-SLP
• Isd Canton LLC (Northwest Georgia Dialysis)
• Isd Renal Inc (Northwest Georgia Dialysis)
• Rayllensons Itacy, P.A.
• Vladislav Ivanchenko, OD
• Jabez Wellness
• Alexa Jackson, MS CF-SLP
• Leslie Schaad Jackson, FNP-C

• Physician Assistant in Canton, GA
• Providers in Canton, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.