| Kennesaw Mountain Medical Group | |
|
1600 Kennesaw Due West Rd Nw Building 600 Suite 625 Kennesaw GA 30152-4301 | |
| (770) 422-5880 | |
| Not Available |
| Full Name | Kennesaw Mountain Medical Group |
|---|---|
| Speciality | Clinic/Center |
| Location | 1600 Kennesaw Due West Rd Nw, Kennesaw, Georgia |
| Authorized Official Name and Position | Gregory J Matechak (PHYSICIAN) |
| Authorized Official Contact | 7704225880 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kennesaw Mountain Medical Group 1600 Kennesaw Due West Rd Nw Building 600 Suite 625 Kennesaw GA 30152-4301 Ph: (770) 422-5880 | Kennesaw Mountain Medical Group 1600 Kennesaw Due West Rd Nw Building 600 Suite 625 Kennesaw GA 30152-4301 Ph: (770) 422-5880 |
| NPI Number | 1235378324 |
|---|---|
| Provider Enumeration Date | 02/12/2009 |
| Last Update Date | 02/12/2009 |
| Medicare PECOS PAC ID | 0749328524 |
|---|---|
| Medicare Enrollment ID | O20091116000490 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235378324 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 52992 (Georgia) | Primary |
| Provider Name | Gregory J Matechak |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851492672 PECOS PAC ID: 2769456946 Enrollment ID: I20040824000130 |
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