Healthcare Provider Details

I. General information

NPI: 1831172709
Provider Name (Legal Business Name): MATTHEW T KIRBY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 01/07/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5670 PEACHTREE DUNWOODY RD SUITE 1280
ATLANTA GA
30342-1699
US

IV. Provider business mailing address

3495 PIEDMONT RD NE ATTN:TOBIE SHELLEY
ATLANTA GA
30305-1717
US

V. Phone/Fax

Practice location:
  • Phone: 404-257-1589
  • Fax: 404-303-1950
Mailing address:
  • Phone: 404-365-0966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number56730
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: