Provider Demographics
NPI:1689667933
Name:PACITTI, ELISE (NP)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:PACITTI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 CHURCH ST NE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7282
Mailing Address - Country:US
Mailing Address - Phone:678-797-8201
Mailing Address - Fax:678-290-8325
Practice Address - Street 1:790 CHURCH ST NE
Practice Address - Street 2:SUITE 250
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7282
Practice Address - Country:US
Practice Address - Phone:678-797-8201
Practice Address - Fax:678-290-8325
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA099451363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00197553OtherRAILROAD MEDICARE
GA390946OtherWELLCARE
GA50BBHXPMedicare ID - Type Unspecified
GA390946OtherWELLCARE