Individual
ATHENA JACOWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2258 NORTHLAKE PKWY, 390, TUCKER, GA 30084-4019
(678) 754-3507
Mailing address
1631 BRENTWOOD XING SE, CONYERS, GA 30013-6300
(678) 754-3507
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
CO078139
GA
Other
Enumeration date
03/22/2016
Last updated
03/22/2016
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