IndividualActive
Athena Jacoway
NPI 1376905117 · Prosthetics Case Management · Tucker, GA
Provider details
- NPI number
- 1376905117
- Entity type
- Individual
- Primary specialty
- Prosthetics Case ManagementOther Service Providers
- Sex
- Female
- Sole proprietor
- Yes
- License
- CO078139 (GA)
Specialties & taxonomies
Other Service Providers
Practice location
2258 Northlake Pkwy
390
Tucker, GA 30084-4019
Phone: (678) 754-3507
Approximate (ZIP-level) locationGet directions
Mailing address
1631 Brentwood Xing Se
Conyers, GA 30013-6300
Registry dates
- Enumerated
- 2016-03-22
- Last updated
- 2016-03-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.