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1255888244
JESSE MARK DIVAKAR
MACON, GA
NPI
1255888244
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225100000X Physical Therapist
(Licence: GA PT012644)
Enumeration Date
2016-09-07
Last Update Date
2018-06-16
Business Address
Mr. JESSE MARK DIVAKAR DPT
3708 NORTHSIDE DR
MACON, GA 31210
Phone number: 478-254-5303
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Mailing Address
Mr. JESSE MARK DIVAKAR DPT
3708 NORTHSIDE DR
MACON, GA 31210-2404
Phone number: 478-254-5303
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