MEDICARE: DR. RESSY MATHEWS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	49392	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GRP2048	OTHER	GA	MEDICARE GROUP NUMBER

General Provider Information

NPI Number	:	1700847894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RESSY MATHEWS MD

Provider Business Mailing Address
First Line	:	4331 THURMOND TANNER RD
Second Line	:
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-2829
Country	:	US
Telephone Number	:	678-513-5700
Fax Number	:	678-513-5836

Provider Business Practice Location Address
First Line	:	4331 THURMOND TANNER RD
Second Line	:
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-2829
Country	:	US
Telephone Number	:	678-513-5700
Fax Number	:	678-513-5836

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	09/11/2007

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