MEDICARE: MATTHEW M RALSTEN 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	207V00000X	Obstetrics & Gynecology Physician	057827	GA

General Provider Information

NPI Number	:	1184654394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW M RALSTEN M.D.

Provider Business Mailing Address
First Line	:	1267 HIGHWAY 54 WEST
Second Line	:	SUITE 3200
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214
Country	:	US
Telephone Number	:	770-632-9900
Fax Number	:	770-632-9997

Provider Business Practice Location Address
First Line	:	1267 HIGHWAY 54 WEST
Second Line	:	SUITE 3200
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214
Country	:	US
Telephone Number	:	770-632-9900
Fax Number	:	770-632-9997

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	07/08/2007

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