Individual provider · NPI-1

Jeancarlo Alencastro, ATC/L

Specialist/Technologist, Athletic Trainer · Atlanta, GA

NPI number1891025235
StatusActive
Last updated in NPPESJan 5, 2015

Details

NPI
1891025235
Entity type
Individual (NPI-1)
Name
Jeancarlo Alencastro
Credential
ATC/L
Sex
Male
Sole proprietor
Yes
Enumeration date
Jan 7, 2010
Last updated
Jan 5, 2015

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2255A2300X Specialist/Technologist, Athletic TrainerAT001665GAYes

Practice location

777 Cleveland Ave Sw Suite 406
Atlanta, GA 30315-7101

Phone 404-228-3112 · Fax 404-763-0135

Mailing address

117 B Valleywood Rd
Tyrone, GA 30290

Phone 678-852-8091

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