Provider Demographics
NPI:1669986709
Name:THOMAS CHACKO M.D. P.C
Entity type:Organization
Organization Name:THOMAS CHACKO M.D. P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCMA
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEZEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-779-0421
Mailing Address - Street 1:330 NEWCASTLE DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-7162
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 NEWCASTLE DR
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-7162
Practice Address - Country:US
Practice Address - Phone:404-983-6288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-28
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========Medicaid