MEDICARE: DR. RYAN MATHEW M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	44728	AL
2	207R00000X	Internal Medicine Physician	125.068511	IL
3	207RR0500X	Rheumatology Physician	105539	GA

General Provider Information

NPI Number	:	1043664899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN MATHEW M.D.

Provider Business Mailing Address
First Line	:	11731 POINTE PL
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076-4636
Country	:	US
Telephone Number	:	770-284-3150
Fax Number	:	770-284-3170

Provider Business Practice Location Address
First Line	:	4255 WADE GREEN RD NW STE 925
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30144-1280
Country	:	US
Telephone Number	:	770-284-3150
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2016
Last Update Date	:	10/16/2025

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