Healthcare Provider Details

I. General information

NPI: 1033790076
Provider Name (Legal Business Name): ZACHARY CASTO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 11/09/2025
Certification Date: 11/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 HAWKS LN NE
BROOKHAVEN GA
30329-2283
US

IV. Provider business mailing address

1968 HAWKS LN NE
BROOKHAVEN GA
30329-2283
US

V. Phone/Fax

Practice location:
  • Phone: 419-578-7510
  • Fax:
Mailing address:
  • Phone: 404-778-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number104405
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: