Basic Information
| Provider Information | |||||||||
| NPI: | 1689667933 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PACITTI | ||||||||
| FirstName: | ELISE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 790 CHURCH ST NE | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300607282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6787978201 | ||||||||
| FaxNumber: | 6782908325 | ||||||||
| Practice Location | |||||||||
| Address1: | 790 CHURCH ST NE | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300607282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6787978201 | ||||||||
| FaxNumber: | 6782908325 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2005 | ||||||||
| LastUpdateDate: | 10/24/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 099451 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | P00197553 | 01 | GA | RAILROAD MEDICARE | OTHER | 390946 | 01 | GA | WELLCARE | OTHER |