Healthcare Provider Details

I. General information

NPI: 1356835664
Provider Name (Legal Business Name): MATTHEW JAMES VOSTERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 08/07/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 MERIDIAN MARK RD STE 250
ATLANTA GA
30342-4767
US

IV. Provider business mailing address

5445 MERIDIAN MARK RD STE 250
ATLANTA GA
30342-4767
US

V. Phone/Fax

Practice location:
  • Phone: 404-255-1933
  • Fax:
Mailing address:
  • Phone: 404-255-1933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number96557
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301115577
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number35.144769
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: