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General NPI Number Information
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NPI Number | 1992105258
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Entity Type | Organization
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Legal Business Name | MY MATRIX, INCORPORATED
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Dates
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Enumeration Date | 08/23/2014
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Last Update Date | 08/23/2014
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Provider Practice Location Address
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Address Line | 2640 MARTIN LUTHER KING JR DR SW
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City | ATLANTA
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State | GA
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Zip | 30311-6101
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Country | US
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Telephone | 770-407-9288
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20287
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City | ATLANTA
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State | GA
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Zip | 30325-0287
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PEER SPECIALIST
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Name | MS. FELICIA MOSES
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Credential |
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Telephone | 770-407-9288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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