Provider Demographics
NPI:1023524717
Name:CHARAKLA, FATIMA A (DPT)
Entity type:Individual
Prefix:DR
First Name:FATIMA
Middle Name:A
Last Name:CHARAKLA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:FATIMA
Other - Middle Name:
Other - Last Name:HUSSAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:94 KENT VALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-8490
Mailing Address - Country:US
Mailing Address - Phone:404-429-7438
Mailing Address - Fax:
Practice Address - Street 1:1600 MEDICAL WAY STE 150
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078
Practice Address - Country:US
Practice Address - Phone:770-978-5328
Practice Address - Fax:770-979-7312
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2023-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0132042251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic