Healthcare Provider Details

I. General information

NPI: 1033115258
Provider Name (Legal Business Name): ABUL FAIZ MOHAMMAD MATIN M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

993 JOHNSON FERRY RD STE C300
ATLANTA GA
30342-1658
US

IV. Provider business mailing address

993 JOHNSON FERRY RD STE C300
ATLANTA GA
30342-1658
US

V. Phone/Fax

Practice location:
  • Phone: 404-257-0080
  • Fax: 404-257-0592
Mailing address:
  • Phone: 404-257-0080
  • Fax: 404-257-0592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number43697
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: