Healthcare Provider Details

I. General information

NPI: 1134307705
Provider Name (Legal Business Name): MATTHEW EDWARD ZYGMONT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON ROAD NE EMORY UNIVERSITY HOSPITAL
ATLANTA GA
30322
US

IV. Provider business mailing address

1364 CLIFTON ROAD NE EMORY UNIVERSITY RADIOLOGY RM D-125A
ATLANTA GA
30322
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-4686
  • Fax:
Mailing address:
  • Phone: 404-712-4686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number060202
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: