Doctor Name: | DR. MATHEW LEVINE |
NPI Number: | 1053621078 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | OT013214 |
Business Practice Address: | 1100 Northside Forsyth Dr Suite 340 Cumming, GA - 300416012 |
Business Phone Number: | 7708868111 |
Business Fax Number: | 7702058539 |
Mailing Address: | 1100 Northside Forsyth Dr, Suite 340 CUMMING |
State: | GA |
Postal Code: | 300416012 |
Phone Number: | 7708868111 |
Fax Number: | 7702058539 |
NPI Enumeration Date: | 10/08/2010 |
NPI Last Update Date: | 03/17/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | OT013214 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | PA |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |