MEDICARE: MATTHEW WINSLOW

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	106S00000X	Behavior Technician	909609	GA

General Provider Information

NPI Number	:	1063227189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW WINSLOW

Provider Business Mailing Address
First Line	:	2026 TWIN FALLS RD
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30032
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	629 AIRPORT RD # P
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-4474
Country	:	US
Telephone Number	:	678-255-0597
Fax Number	:

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

Provider Enumeration Date	:	02/07/2025
Last Update Date	:	02/07/2025

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Directions to “ MATTHEW WINSLOW ” Practice Location

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