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General NPI Number Information
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NPI Number | 1538954706
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Entity Type | Individual
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Provider Name | ALLEGRA MATTHEWS
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Gender | Female
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Dates
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Enumeration Date | 04/10/2025
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 2220 N DRUID HILLS RD NE
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City | ATLANTA
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State | GA
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Zip | 30329-3117
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Country | US
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Telephone | 404-785-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 417 ARMSTRONG WAY
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City | EVANS
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State | GA
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Zip | 30809-6712
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Country | US
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Telephone | 706-830-6543
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Fax |
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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 | 363LP0222X
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Taxonomy Name | Critical Care Pediatric Nurse Practitioner
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License Number | RN118131
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License Number State | GA
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