Healthcare Provider Details

I. General information

NPI: 1821799040
Provider Name (Legal Business Name): MATTHEW STENZEL NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 PEACHTREE PKWY STE 302
CUMMING GA
30041-6834
US

IV. Provider business mailing address

755 SPRINGROCK DR
LAWRENCEVILLE GA
30043-2172
US

V. Phone/Fax

Practice location:
  • Phone: 770-772-1830
  • Fax:
Mailing address:
  • Phone: 404-558-3716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number258854
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: