Provider Demographics
NPI:1699853937
Name:TUCCI-PEARSON, JACQUELINE T (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:T
Last Name:TUCCI-PEARSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:TUCCI-PEARSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3180 NORTHPOINT PARKWAY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4419
Mailing Address - Country:US
Mailing Address - Phone:678-205-9004
Mailing Address - Fax:678-205-9005
Practice Address - Street 1:3180 N POINT PKWY
Practice Address - Street 2:SUITE 303
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4248
Practice Address - Country:US
Practice Address - Phone:678-205-9004
Practice Address - Fax:678-205-9005
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045646207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11BDTJNMedicare ID - Type Unspecified
GAG90438Medicare UPIN