Provider Demographics
NPI:1710203500
Name:PACCIONE, RACHEL JOSEPHINE (MD)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:JOSEPHINE
Last Name:PACCIONE
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 1:3630 SAVANNAH PL
Mailing Address - Street 2:BUILDING 100 SUITE B
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5028
Mailing Address - Country:US
Mailing Address - Phone:678-474-0203
Mailing Address - Fax:678-474-0207
Practice Address - Street 1:3630 SAVANNAH PL STE B
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5028
Practice Address - Country:US
Practice Address - Phone:678-474-0203
Practice Address - Fax:678-474-0207
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA071608207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003147223AMedicaid
GAGRP3569OtherOPTOUT