Provider Demographics
NPI:1023444601
Name:CRUTCHFIELD, RACHELLE CARIELLO (PA-C)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:CARIELLO
Last Name:CRUTCHFIELD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RACHELLE
Other - Middle Name:
Other - Last Name:CARIELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3150 ROSWELL RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1858
Mailing Address - Country:US
Mailing Address - Phone:770-637-2919
Mailing Address - Fax:
Practice Address - Street 1:3150 ROSWELL RD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1858
Practice Address - Country:US
Practice Address - Phone:770-637-2919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107332363A00000X
GA7525363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical