NPIMap

Individual provider Active NPI

Issarang Nuchprayoon, MD PHD

  • Pediatrics Physician
  • Jonesboro, GA
National Provider Identifier
1912054289
Registry record updated Nov 14, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
59101 Issued in GA
Practice address
216 Arrowhead Blvd
Jonesboro, GA 30236-1102
Phone
(678) 852-6490
NPI assigned
Jan 5, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 14, 2009

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X D42535 MD
Pediatrics Physician 208000000X 4301053965 MI
Pediatrics Physician 208000000X 59101 GA Primary
Pediatrics Physician 208000000X MD00047463 WA

Addresses

Primary practice location

216 Arrowhead Blvd
Jonesboro, GA 30236-1102

Mailing address

216 Arrowhead Blvd
Jonesboro, GA 30236-1102
Phone (678) 852-6490

Other names 1

  • Dr. Issarang Porn Nuchprayoon Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
59101GAMDPediatrics Physician
D42535MDMDPediatrics Physician
4301053965MIMDPediatrics Physician
MD00047463WAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Moses Lake Community Health Center Past Accepting new patients
Moses Lake Community Health Center Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258156800000",
    "number": "1912054289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 ARROWHEAD BLVD",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302361102",
            "telephone_number": "678-852-6490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 ARROWHEAD BLVD",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302361102",
            "telephone_number": "678-852-6490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NUCHPRAYOON",
        "first_name": "ISSARANG",
        "name_prefix": "Dr.",
        "credential": "MD PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-05",
        "last_updated": "2009-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D42535",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301053965",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "59101",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00047463",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ISSARANG",
            "last_name": "NUCHPRAYOON",
            "middle_name": "PORN",
            "prefix": "DR.",
            "credential": "MD PHD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Jonesboro, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.