Provider Demographics
NPI:1356443089
Name:CHACKO, THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:CHACKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 BROOKSIDE PKWY STE 203
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4425
Mailing Address - Country:US
Mailing Address - Phone:267-226-3181
Mailing Address - Fax:888-823-1934
Practice Address - Street 1:3905 BROOKSIDE PKWY STE 203
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-4425
Practice Address - Country:US
Practice Address - Phone:267-226-3181
Practice Address - Fax:888-823-1934
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA59383207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA59383OtherGEORGIA MEDICAL LICENSE