Healthcare Provider Details

I. General information

NPI: 1336167535
Provider Name (Legal Business Name): ROBERT G MATHENY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5671 PEACHTREE DUNWOODY RD NE STE 550
ATLANTA GA
30342-5013
US

IV. Provider business mailing address

5671 PEACHTREE DUNWOODY RD NE STE 550
ATLANTA GA
30342-5013
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-9063
  • Fax: 404-252-0873
Mailing address:
  • Phone: 404-252-9063
  • Fax: 404-252-0873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number046990
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: