B Mata LLC
Family Medicine, Geriatric Medicine in Gainesville, GA. Organization (NPI-2).
NPI number1295366292
StatusActive
Last updated in NPPESJan 28, 2020
Details
- NPI
- 1295366292
- Entity type
- Organization (NPI-2)
- Legal business name
- B Mata LLC
- Organization subpart
- No
- Enumeration date
- Jan 28, 2020
- Certification date
- Jan 28, 2020
- Last updated
- Jan 28, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207QG0300X | Family Medicine, Geriatric Medicine | – | – | Yes |
Other names
- Centro Medico San Lucas (Doing Business As)
Practice location
1631 Atlanta HwyGainesville, GA 30504-5942
Phone 770-718-1517 · Fax 770-718-1518
Mailing address
1631 Atlanta HwyGainesville, GA 30504-5942
Phone 770-718-1517 · Fax 770-718-1518
Other practice locations
4292 Chamblee Tucker Rd
Tucker, GA 30084-2103
Tucker, GA 30084-2103
Phone 770-718-1517 · Fax 770-718-1518
Authorized official
Byron Oswaldo Mata Gonzalez
Owner
7864274450
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