Individual
MRS. MARY JINCY CHACKONAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSPT
Contact information
Practice address
3100 CLUB DR, LAWRENCEVILLE, GA 30044-2591
(770) 923-3100
Mailing address
3100 CLUB DR, LAWRENCEVILLE, GA 30044-2591
(770) 923-3100
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT008253
GA
Other
Enumeration date
01/23/2013
Last updated
01/23/2013
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