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General NPI Number Information
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NPI Number | 1043664899
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Entity Type | Individual
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Provider Name | RYAN MATHEW M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/19/2016
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 4255 WADE GREEN RD NW STE 925
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City | KENNESAW
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State | GA
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Zip | 30144-1280
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Country | US
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Telephone | 770-284-3150
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Fax |
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Provider Business Mailing Address
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Address Line | 11731 POINTE PL
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City | ROSWELL
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State | GA
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Zip | 30076-4636
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Country | US
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Telephone | 770-284-3150
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Fax | 770-284-3170
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 44728
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 125.068511
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 105539
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License Number State | GA
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