Healthcare Provider Details

I. General information

NPI: 1477834398
Provider Name (Legal Business Name): JESSICA ESTHER HARROCHE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 HURRICANE SHOALS RD NW STE 301
LAWRENCEVILLE GA
30046-8761
US

IV. Provider business mailing address

595 HURRICANE SHOALS RD NW STE 301
LAWRENCEVILLE GA
30046-8761
US

V. Phone/Fax

Practice location:
  • Phone: 470-325-1280
  • Fax: 678-701-9857
Mailing address:
  • Phone: 470-325-1280
  • Fax: 678-701-9857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number77969
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: