Basic Information
| Provider Information | |||||||||
| NPI: | 1710203500 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PACCIONE | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | JOSEPHINE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3630 SAVANNAH PL | ||||||||
| Address2: | BUILDING 100 SUITE B | ||||||||
| City: | DULUTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300965028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6784740203 | ||||||||
| FaxNumber: | 6784740207 | ||||||||
| Practice Location | |||||||||
| Address1: | 3630 SAVANNAH PL STE B | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300965028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6784740203 | ||||||||
| FaxNumber: | 6784740207 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2010 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 207V00000X | 071608 | GA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 003147223A | 05 | GA | MEDICAID | GRP3569 | 01 | GA | OPTOUT | OTHER |