Individual
JEANCARLO ALENCASTRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC/L
Contact information
Practice address
777 CLEVELAND AVE SW SUITE 406, ATLANTA, GA 30315-7101
(404) 228-3112
(404) 763-0135
Mailing address
117 B VALLEYWOOD RD, TYRONE, GA 30290
(678) 852-8091
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT001665
GA
Other
Enumeration date
01/07/2010
Last updated
01/05/2015
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