Provider Demographics
NPI:1447437322
Name:BONACCORSI, PAOLA (MD)
Entity type:Individual
Prefix:DR
First Name:PAOLA
Middle Name:
Last Name:BONACCORSI
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 1:6470 E JOHNS XING STE 200
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1539
Mailing Address - Country:US
Mailing Address - Phone:470-282-5729
Mailing Address - Fax:
Practice Address - Street 1:6470 E JOHNS XING STE 200
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1539
Practice Address - Country:US
Practice Address - Phone:470-282-5729
Practice Address - Fax:770-674-5795
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001588207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology