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NPI Code Detail

MEDICARE: DR. MATTHEW AGAM MD

MEDICARE: DR. MATTHEW AGAM MD
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
1207T00000XNeurological Surgery Physician28457NV
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1720540990
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW AGAM MD
Provider Business Mailing Address
First Line : 1365B CLIFTON RD NE RM B6169C
Second Line :
City : ATLANTA
State : GA
Zip : 30322-1059
Country : US
Telephone Number : 404-778-2190
Fax Number : 404-778-4472
Provider Business Practice Location Address
First Line : 1365B CLIFTON RD NE RM B6169C
Second Line :
City : ATLANTA
State : GA
Zip : 30322-1059
Country : US
Telephone Number : 404-778-2190
Fax Number : 404-778-4472
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2019
Last Update Date : 03/24/2026

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