Provider Demographics
NPI:1275776353
Name:EACCARINO, ALEXANDRE KRISTIAN (DO)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRE
Middle Name:KRISTIAN
Last Name:EACCARINO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5780 PEACHTREE DUNWOODY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1513
Mailing Address - Country:US
Mailing Address - Phone:404-433-5650
Mailing Address - Fax:
Practice Address - Street 1:11975 MORRIS RD STE 200
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4444
Practice Address - Country:US
Practice Address - Phone:770-410-4388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067211207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003136311AMedicaid
GA202I425668OtherMEDICARE