MEDICARE: MRS. MARTHA MATHISON M.ED.

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1639450489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARTHA MATHISON M.ED.

Provider Business Mailing Address
First Line	:	234 PARKVIEW DR
Second Line	:
City	:	CARTERSVILLE
State	:	GA
Zip	:	30120-4052
Country	:	US
Telephone Number	:	770-382-1879
Fax Number	:	770-382-2601

Provider Business Practice Location Address
First Line	:	1955 LAKE PARK DR SE STE 300
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-8855
Country	:	US
Telephone Number	:	770-514-2462
Fax Number	:	770-514-2803

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

Provider Enumeration Date	:	09/07/2011
Last Update Date	:	09/07/2011

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