Healthcare Provider Details

I. General information

NPI: 1346413648
Provider Name (Legal Business Name): MATHEW WILLIAM POMBO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 PLEASANT HILL RD STE 470
DULUTH GA
30096-1417
US

IV. Provider business mailing address

3855 PLEASANT HILL RD STE 470
DULUTH GA
30096-1417
US

V. Phone/Fax

Practice location:
  • Phone: 770-813-8888
  • Fax:
Mailing address:
  • Phone: 770-813-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMT191685
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number61262
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: