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General NPI Number Information
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NPI Number | 1295611077
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Entity Type | Organization
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Legal Business Name | MATRIARCH MEDICAL LLC
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Dates
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Enumeration Date | 08/15/2025
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 155 BANKERS BLVD STE E200
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City | MONROE
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State | GA
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Zip | 30655-7724
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Country | US
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Telephone | 770-652-8762
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Fax |
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Provider Business Mailing Address
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Address Line | 2735 HESTER TOWN RD
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City | MONROE
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State | GA
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Zip | 30655-7634
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Country | US
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Telephone | 770-652-8762
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Fax |
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Authorized Official
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Title or Position | OWNER/SOLE PROPRIETOR
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Name | MS. AMY SARGENT
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Credential | FNP-C
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Telephone | 770-652-8762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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