Individual
JACOB CHANDLER FOGARTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
124 3RD ST, MACON, GA 31201-3404
(478) 662-0156
Mailing address
2 MASHBURN ST STE 102, HAWKINSVILLE, GA 31036-4961
(478) 488-3359
(478) 488-3359
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT014840
GA
Other
Enumeration date
07/19/2022
Last updated
07/19/2022
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