Healthcare Provider Details

I. General information

NPI: 1639244908
Provider Name (Legal Business Name): ELAINE F MATEO M.D. PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 PEACHTREE DUNWOODY RD SUITE 330
ATLANTA GA
30342-1703
US

IV. Provider business mailing address

5555 PEACHTREE DUNWOODY RD SUITE 330
ATLANTA GA
30342-1703
US

V. Phone/Fax

Practice location:
  • Phone: 404-448-3394
  • Fax: 404-256-8227
Mailing address:
  • Phone: 404-448-3394
  • Fax: 404-256-8227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number035949
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: