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General NPI Number Information
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NPI Number | 1851492672
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Entity Type | Individual
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Provider Name | GREGORY J. MATECHAK M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 1650 CHATTAHOOCHEE DR
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City | ROCKMART
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State | GA
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Zip | 30153-2023
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Country | US
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Telephone | 770-684-6100
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Fax | 770-684-7522
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Provider Business Mailing Address
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Address Line | 420 E 2ND AVE SUITE 103
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City | ROME
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State | GA
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Zip | 30161-3209
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Country | US
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Telephone | 706-509-3278
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 52992
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License Number State | GA
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