Healthcare Provider Details

I. General information

NPI: 1023535085
Provider Name (Legal Business Name): ANDREA YVETTE MATHADOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5775 PEACHTREE DUNWOODY RD NE
SANDY SPRINGS GA
30342-1501
US

IV. Provider business mailing address

2805 HAMILTON MILL RD
BUFORD GA
30519-4110
US

V. Phone/Fax

Practice location:
  • Phone: 763-361-7338
  • Fax: 844-673-9314
Mailing address:
  • Phone: 678-541-0588
  • Fax: 678-541-0610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25401
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3-000145
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN181680
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5016199
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3015726
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number904633
License Number StateMS
# 7
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28799
License Number StateTN
# 8
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number219610
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: