Individual provider Active NPI

Fabiola Nneka Panchetti, PA

  • Physician Assistant
  • Atlanta, GA
National Provider Identifier
1457746703
Registry record updated Apr 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
7543 Issued in GA
Practice address
235 Peachtree St NE
#2100
Atlanta, GA 30303-1401
Phone
(770) 994-9326
Fax
(404) 080-9428
NPI assigned
Apr 3, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 7543 GA Primary

Addresses

Primary practice location

235 Peachtree St NE
#2100
Atlanta, GA 30303-1401

Mailing address

235 Peachtree St NE
#2100
Atlanta, GA 30303-1401
Phone (770) 994-9326

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150617000530 GA Practitioner - Physician Assistant 3779894738 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
007543GAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Georgia Em-I Medical Services, LLC Physician Assistant CurrentSince Oct 29, 2021 Accepting new patients
Lavender Inpatient Services LLC Past Accepting new patients
Mount Lassen Emergency Physicians LLC Past Accepting new patients

Locations

3651 Wheeler Rd
Augusta, GA 30909
Phone (706) 651-3232

5126 Hospital Dr NE
Covington, GA 30014
Phone (770) 385-4340

11 Upper Riverdale Rd SW
Riverdale, GA 30274
Phone (770) 897-7277

1700 Medical Way
Snellville, GA 30078
Phone (770) 978-4229

1133 Eagles Landing Pkwy
Stockbridge, GA 30281
Phone (678) 604-1000

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1428019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428019200000",
    "number": "1457746703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 PEACHTREE ST NE",
            "address_2": "#2100",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303031401",
            "telephone_number": "770-994-9326",
            "fax_number": "404-080-9428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 PEACHTREE ST NE",
            "address_2": "#2100",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303031401",
            "telephone_number": "770-994-9326",
            "fax_number": "404-080-9428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANCHETTI",
        "first_name": "FABIOLA",
        "middle_name": "NNEKA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-03",
        "last_updated": "2015-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "7543",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.