Healthcare Provider Details
I. General information
NPI: 1093107799
Provider Name (Legal Business Name): ANJHARI MATTHEWS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 03/04/2015
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1121 JOHNSON FERRY RD STE 350
MARIETTA GA
30068-5420
US
IV. Provider business mailing address
643 MAIN ST
PALMETTO GA
30268-1138
US
V. Phone/Fax
- Phone: 770-709-6382
- Fax: 770-727-0201
- Phone: 770-709-6382
- Fax: 770-727-0201
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LC1500X |
| Taxonomy | Community Health Nurse Practitioner |
| License Number | AP07779 |
| License Number State | LA |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | 258990 |
| License Number State | GA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: