Healthcare Provider Details

I. General information

NPI: 1740217017
Provider Name (Legal Business Name): MATTHEW A DOVIE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 LIMESTONE OVERLOOK
GAINESVILLE GA
30501-7443
US

IV. Provider business mailing address

3525 PIEDMONT RD NE #7-601
ATLANTA GA
30305-1578
US

V. Phone/Fax

Practice location:
  • Phone: 770-297-0356
  • Fax:
Mailing address:
  • Phone: 404-842-5425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003457
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: