MEDICARE: CAROL ANN MATHESON PH.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	103TC2200X	Clinical Child & Adolescent Psychologist	2676	GA

General Provider Information

NPI Number	:	1922156074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL ANN MATHESON PH.D.

Provider Business Mailing Address
First Line	:	2970 PEACHTREE RD NW STE 110
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2110
Country	:	US
Telephone Number	:	678-571-7320
Fax Number	:

Provider Business Practice Location Address
First Line	:	2970 PEACHTREE RD NW STE 110
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2110
Country	:	US
Telephone Number	:	678-571-7320
Fax Number	:

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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