Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT013204 | GA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT013204 | GA |
NPI | 1023524717 |
---|---|
Provider Name | Dr. Fatima A Charakla |
First Address | Norcross, GA 30093-3872 |
Second Address | Snellville, GA 30078 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2017 |
Last Update Date | 01/06/2018 |