| Matter Health Of Georgia, Llc | |
|
1900 Perry Blvd Nw Atlanta GA 30318-3500 | |
| (470) 890-0900 | |
| Not Available |
| Full Name | Matter Health Of Georgia, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1900 Perry Blvd Nw, Atlanta, Georgia |
| Authorized Official Name and Position | Mason Mercy (CEO) |
| Authorized Official Contact | 6153060996 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Matter Health Of Georgia, Llc 1131 4th Ave S Ste 210 Nashville TN 37210-2737 Ph: () - | Matter Health Of Georgia, Llc 1900 Perry Blvd Nw Atlanta GA 30318-3500 Ph: (470) 890-0900 |
| NPI Number | 1770230997 |
|---|---|
| Provider Enumeration Date | 03/08/2022 |
| Last Update Date | 05/28/2024 |
| Medicare PECOS PAC ID | 2668847443 |
|---|---|
| Medicare Enrollment ID | O20230410000487 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770230997 | NPI | - | NPPES |
| 003283339A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Lucas Golub |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467710848 PECOS PAC ID: 1254641988 Enrollment ID: I20151110001211 |
| Provider Name | Grady Bazzel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396998241 PECOS PAC ID: 9739474040 Enrollment ID: I20160825002348 |
| Provider Name | Victoria Randle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083083810 PECOS PAC ID: 6002118197 Enrollment ID: I20230710000053 |
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