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General NPI Number Information
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NPI Number | 1669986709
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Entity Type | Organization
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Legal Business Name | THOMAS CHACKO M.D. P.C
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Dates
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Enumeration Date | 11/28/2017
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 3905 BROOKSIDE PKWY STE 203
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City | ALPHARETTA
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State | GA
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Zip | 30022-4425
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Country | US
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Telephone | 678-668-4688
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Fax |
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Provider Business Mailing Address
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Address Line | 3905 BROOKSIDE PKWY STE 203
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City | ALPHARETTA
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State | GA
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Zip | 30022-4425
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Country | US
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Telephone | 678-668-4688
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | USHA MARIAM CHACKO
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Credential |
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Telephone | 678-668-4688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number |
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License Number State |
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