Provider Demographics
NPI:1649856451
Name:JACKOVITCH, CHELSEA MARIE (HAD)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:MARIE
Last Name:JACKOVITCH
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:MARIE
Other - Last Name:ATKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HAD
Mailing Address - Street 1:59 W CANDLER ST
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-2558
Mailing Address - Country:US
Mailing Address - Phone:770-938-2400
Mailing Address - Fax:
Practice Address - Street 1:59 W CANDLER ST
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-2558
Practice Address - Country:US
Practice Address - Phone:770-938-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHAA000168237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist