Provider Demographics
NPI:1477834398
Name:HARROCHE, JESSICA ESTHER (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ESTHER
Last Name:HARROCHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 HURRICANE SHOALS RD NW STE 301
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8761
Mailing Address - Country:US
Mailing Address - Phone:470-325-1280
Mailing Address - Fax:678-701-9857
Practice Address - Street 1:595 HURRICANE SHOALS RD NW STE 301
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8761
Practice Address - Country:US
Practice Address - Phone:470-325-1280
Practice Address - Fax:678-701-9857
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA77969207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program