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General NPI Number Information
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NPI Number | 1144024829
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Entity Type | Organization
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Legal Business Name | MATIAS HEALTH CHIROPRACTIC II LLC
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Dates
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Enumeration Date | 04/02/2025
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 2310 BROCKETT RD
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City | TUCKER
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State | GA
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Zip | 30084-4416
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Country | US
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Telephone | 470-800-4041
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Fax | 403-403-4014
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Provider Business Mailing Address
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Address Line | 10800 ALPHARETTA HWY STE 208-588
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City | ROSWELL
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State | GA
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Zip | 30076-1490
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Country | US
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Telephone | 470-800-4041
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Fax | 470-403-4014
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Authorized Official
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Title or Position | CEO
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Name | SOAMMY L MATIAS
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Credential | DC
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Telephone | 470-800-4041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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