Provider Demographics
NPI:1649034265
Name:SCUDERI, RACHELLE YVONNE (DO)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:YVONNE
Last Name:SCUDERI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:RACHELLE
Other - Middle Name:YVONNE
Other - Last Name:GIBBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 EAST HOSPITAL ROAD
Mailing Address - Street 2:
Mailing Address - City:FORT EISENHOWER
Mailing Address - State:GA
Mailing Address - Zip Code:30905
Mailing Address - Country:US
Mailing Address - Phone:706-787-3000
Mailing Address - Fax:706-787-5836
Practice Address - Street 1:DWIGHT DAVID EISENHOWER ARMY MEDICAL CENTER
Practice Address - Street 2:300 EAST HOSPITAL ROAD
Practice Address - City:FORT EISENHOWER
Practice Address - State:GA
Practice Address - Zip Code:30905-5650
Practice Address - Country:US
Practice Address - Phone:805-630-5409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA105489208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program