B MATA LLC (NPI# 1295366292) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295366292 |
| Entity Type | Organization |
| Organization Name | B MATA LLC |
| Practice Address |
1631 Atlanta Hwy Gainesville GA 30504-5942 |
| Practice Telephone | 7707181517 |
| Practice Fax Number | 7707181518 |
| Mailing Telephone | 7707181517 |
| Mailing Fax Number | 7707181518 |
| Enumeration Date | 2020-01-28 |
| Last Update Date | 2020-01-28 |
| Authorized Official Name | BYRON OSWALDO MATA GONZALEZ (OWNER) |
| Authorized Official Telephone | 7864274450 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Centro Medico San Lucas | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4292 Chamblee Tucker Rd, Tucker, GA 300842103 | 7707181517 | 7707181518 |
| Street Address |
1631 ATLANTA HWY |
| City | GAINESVILLE |
| State | GA |
| Zip Code | 30504-5942 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174124572 | Jessica Rodriguez New | Pharmacist | 2892 Browns Bridge Road, Gainesville, GA 30504 | 2020-11-03 |
| 1710541461 | Lauren Brooke Taylor | Occupational Therapist | 2900 Mcever Road, Gainesville, GA 30504 | 2019-04-29 |
| 1801023700 | Brenda Levartha Hamilton | Registered Nurse | 3905 Mabry Rd., Gainesville, GA 30504 | 2009-06-18 |
| 1083757645 | Charles Kent Yarbrough | Optometrist | 400 Shallowford Road, Vision Center, Gainesville, GA 30504 | 2007-02-14 |
| 1881746170 | Lisa S. Ralston | Occupational Therapist | 3038 St. Charles Ave., 3038 St. Charles Ave., Gainesville, GA 30504 | 2007-01-17 |
| 1326140690 | David Richards Adamson | Physical Therapist | 3640 Mundy Mill Road, Suite 102b, Oakwood, GA 30504 | 2006-09-05 |
| 1326057621 | Henry Joseph Lewis IIi | Legal Medicine | 5606 Captains Ct, Gainesville, GA 30504 | 2006-08-05 |
| 1992164032 | Hall County Endoscopy Center LLC | Clinic/Center | 1955 Textile Way, Gainesville, GA 30504 | 2016-02-17 |
| 1982902276 | James Minton | Pharmacist | 3640 Mundy Mill Road, Gainesville, GA 30504 | 2011-03-10 |
| 1881758969 | Donna Marie Colavecchio | Occupational Therapy Assistant | 3640 Mundy Mill Road, Suite 102b, Oakwood, GA 30504 | 2006-12-21 |
| Find all providers in zip 30504 | ||||
| Taxonomy Code | 207QG0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Geriatric Medicine |
| A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://wwwtheabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750835211 | Gainesville Geriatric Rehabilitation Medicine LLC | Family Medicine | 5002 Nw 15th Pl, Gainesville, FL 32605-4555 | 2016-08-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558916056 | Newtown Park Medical Clinic and Geriatrics LLC | Family Medicine | 2880 Old Alabama Rd #300, Johns Creek, GA 30022-5033 | 2019-08-02 |
| 1558830919 | Patriot Healthcare of Georgia, LLC | Family Medicine | 833 Hairston Road, Stone Mountain, GA 30083 | 2018-11-15 |
| 1275002636 | Patriot Healthcare of Georgia, LLC | Family Medicine | 1587 Phoenix Boulevard, Suite 6, College Park, GA 30349 | 2018-11-15 |
| 1215471479 | Deana Perkins | Family Medicine | 756 Arrowhead Lake Rd, Thomaston, GA 30286-5004 | 2016-12-07 |
| 1255731741 | Jafar Tabatabai M.d. P.C. | Family Medicine | 7961 Highway 92 Ste 100, Woodstock, GA 30189-5209 | 2014-09-03 |
| 1457604381 | Senior Care Plus Limited Liability Company | Family Medicine | 990 Peachtree Industrial Blvd Number 4532, Suwanee, GA 30024-5249 | 2012-10-16 |
| 1053662296 | Community Primary Care of Georgia LLC | Family Medicine | 946 Veterans Pkwy, Barnesville, GA 30204-3771 | 2012-09-27 |
| 1669770954 | J&a Wood, LLC | Family Medicine | 2724 Grey Fox Ct, Haddock, GA 31033-6009 | 2011-03-10 |
| 1043442080 | Sam Peng Md PC | Family Medicine | 1622 Rivergreen Bnd Se, Atlanta, GA 30339-8546 | 2009-08-10 |
| 1134259369 | Rina Eisenstein | Family Medicine | 215 Arbor Creek Way, Roswell, GA 30076-1291 | 2007-03-06 |
| Find all providers with the same taxonomy | ||||
| City | GAINESVILLE |
| Zip Code | 30504 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.