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General NPI Number Information
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NPI Number | 1669124210
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Entity Type | Individual
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Provider Name | MATTHEW DORSEY SHUGART APC
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Gender | Male
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Dates
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Enumeration Date | 01/25/2022
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Last Update Date | 01/25/2022
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Provider Practice Location Address
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Address Line | 3548 HABERSHAM AT NORTHLAKE
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City | TUCKER
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State | GA
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Zip | 30084-4009
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Country | US
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Telephone | 404-401-2587
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Fax |
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Provider Business Mailing Address
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Address Line | 2344 GLYNN DR SE
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City | ATLANTA
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State | GA
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Zip | 30316-3452
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Country | US
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Telephone | 313-815-5213
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | APCOO8345
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License Number State | GA
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