Healthcare Provider Details

I. General information

NPI: 1841672789
Provider Name (Legal Business Name): JOSEPH EMMANUEL MATHIAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2015
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 CLIFTON RD NE
ATLANTA GA
30329-4021
US

IV. Provider business mailing address

1821 CLIFTON RD NE
ATLANTA GA
30329-4021
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-2430
  • Fax:
Mailing address:
  • Phone: 404-778-2430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number84320
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: