Provider Demographics
NPI:1568605335
Name:CHACKO, SHIKHA REBECCA (MD)
Entity Type:Individual
Prefix:
First Name:SHIKHA
Middle Name:REBECCA
Last Name:CHACKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 IRVIN CT STE 200
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1780
Mailing Address - Country:US
Mailing Address - Phone:404-778-0640
Mailing Address - Fax:404-299-7499
Practice Address - Street 1:505 IRVIN CT STE 200
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1780
Practice Address - Country:US
Practice Address - Phone:404-778-0640
Practice Address - Fax:404-299-7499
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004024207R00000X
GA67541207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003124839Medicaid