MATTHEW CHARLES REVILLA


Address: 1670 Clairmont Rd, Decatur, GA 30033-4004
Phone: 2524148145

MATTHEW CHARLES REVILLA (NPI# 1821617036) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1821617036
Entity Type Individual
Full Name MATTHEW CHARLES REVILLA
Credential PA-C
Practice Address 1670 Clairmont Rd
Decatur
GA 30033-4004
Mailing Address 2584 Patrick Ct Se
Atlanta
GA 30317-3023
Practice Telephone 2524148145
Mailing Telephone 2524148145
Enumeration Date 2020-04-09
Last Update Date 2020-04-09
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207QA0505X Family Medicine
Specialization: Adult Medicine
9684 GA Allopathic & Osteopathic Physicians

Office Location

Street Address 1670 CLAIRMONT RD
City DECATUR
State GA
Zip Code 30033-4004

Providers in the same location

NPI Name Taxonomy Address Enumeration
1356342042 Ketayoun Davari Pharmacist 1670 Clairmont Rd, Decatur, GA 30033-4004 2005-08-03
1730780073 Mojisola Mary Bakare Registered Nurse 1670 Clairmont Rd, Decatur, GA 30033-4004 2020-11-03
1346849189 Jessica Astrid George Social Worker 1670 Clairmont Rd, Decatur, GA 30033-4004 2020-10-22
1841807591 Mallorie Gayle Carroll Psychologist 1670 Clairmont Rd, Decatur, GA 30033-4004 2020-09-28
1164036570 Rachel Heatherly Psychologist 1670 Clairmont Rd, Decatur, GA 30033-4004 2020-09-02
1679186670 Martale Jerrell Davis Psychologist 1670 Clairmont Rd, Decatur, GA 30033-4004 2020-08-28
1619580206 Rosetta Yvette Delancy Social Worker 1670 Clairmont Rd, Decatur, GA 30033-4004 2020-08-25
1760095186 Alaisha Delane Wellons Social Worker 1670 Clairmont Rd, Decatur, GA 30033-4004 2020-08-25
1568074797 Hannah F Martyn Psychologist 1670 Clairmont Rd, Decatur, GA 30033-4004 2020-08-19
1285245308 Meera Gupta Pharmacist 1670 Clairmont Rd, Decatur, GA 30033-4004 2020-08-12
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1922613785 Healing Minds, Helping Hearts, LLC Social Worker 2532 N Decatur Rd, Apt 1304, Decatur, GA 30033 2020-09-09
1700412517 Delana Finney Orthotist Vamc - Atlanta, 1670 Clairmont Rd, Decatur, GA 30033 2020-03-13
1194389353 Katherine Serafen Physician Assistant 2701 N Decatur Road, Ground Floor Suite 520, Decatur, GA 30033 2019-04-23
1194290973 Suzanne Johnson Psychologist Atlanta Va Health Care System, 1670 Clairmont Rd, Decatur, GA 30033 2018-10-09
1245705334 Mcleod Counseling Services, LLC Clinic/Center 2801 N. Decatur Rd, Suite 185, Decatur, GA 30033 2018-10-04
1225514797 Erkin Mirkhatovich Turganov Pharmacist 2951 Cedar Brook Dr, Decatur, GA 30033 2018-07-17
1356834972 Sharlencia Lord Nurse Practitioner 2738 N Decatur Rd # 292-3173, Decatur, GA 30033 2018-06-08
1194213140 Zacarias Yanis Jr. Clinical Neuropsychologist 1276 Mcconnell Drive Ste C., Decatur, GA 30033 2018-04-25
1780181370 Ryan Patton Orthopaedic Surgery 2723 Hollywood Dr, Decatur, GA 30033 2018-04-10
1437669751 Sholanda D Hooper Nurse Practitioner 1601 Clairmont Rd, Decatur, GA 30033 2017-10-02
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Taxonomy Information

Taxonomy Code 207QA0505X
Grouping Allopathic & Osteopathic Physicians
Classification Family Medicine
Specialization Adult Medicine

Taxonomy Definition

Definition to come.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1629586946 Ashley Ferguson Family Medicine 330 N Wyckles Rd, Decatur, IL 62522-1034 2018-01-22
1538586995 Dekalb Gpo LLC Family Medicine 2801 N Decatur Rd, Suite 200, Decatur, GA 30033-5949 2014-03-24
1033498118 Syed Zia Ullah Family Medicine 2536 Lawrenceville Hwy, Decatur, GA 30033-3227 2011-08-08
1457473795 Healing Innovations, P.C. Family Medicine 5040 Snapfinger Woods Dr, Suite 201, Decatur, GA 30035-4020 2007-04-06
1376665463 Family Care Centers Trust Family Medicine 1045 Sycamore Dr, Adminstration, Decatur, GA 30030-1645 2007-04-06
1477672640 Family Care Centers Trust Family Medicine 1045 Sycamore Dr, Decatur, GA 30030-1645 2007-03-28
1689737603 Primary Medical Care Group Family Medicine 5322 Snapfinger Park Dr, Decatur, GA 30035-4040 2006-12-19
1942373089 Song Yol Yu Family Medicine 319 W Delaware St, Decatur, MI 49045-1106 2006-11-16
1609880160 Shainul K Bhatia Family Medicine 1045 Sycamore Dr, Decatur, GA 30030-1645 2006-07-28

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1306464250 Leah Reed Family Medicine 2082 Cherokee Farms Cv, Buford, GA 30519-7004 2020-07-08
1083240766 Carehere LLC Family Medicine 114 N Jackson St, Albany, GA 31701-2583 2020-03-13
1518590744 Octavia Raquel Holloway-freeman Family Medicine 301 Denmark St, Statesboro, GA 30458-5208 2020-02-17
1891331575 Jenna Barnes Family Medicine 1107 Memorial Dr Ste 300, Dalton, GA 30720-8664 2019-11-18
1023651205 Carehere LLC Family Medicine 750 S Perry St Ste 200, Lawrenceville, GA 30046-4804 2019-10-21
1003385733 James G Hamilton Jr Md LLC Family Medicine 4898 Highway 197, Mount Airy, GA 30563-2442 2018-11-26
1780161323 Personal Wellness Inc. Family Medicine 625 Boxwood Ter, Johns Creek, GA 30005-7217 2018-07-26
1073005138 Lake Oconee Wellness Associates LLC Family Medicine 1097 Lake Oconee Pkwy Ste 201, Eatonton, GA 31024-9510 2018-06-05
1376034983 Lee Pennington Mcnichols Family Medicine 2300 Bethelview Rd Ste 110-332, Cumming, GA 30040-9475 2018-05-21
1972021301 Docpecox, LLC Family Medicine 755 Mount Vernon Hwy Ne Ste 350, Atlanta, GA 30328-4291 2017-09-06
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Competitor

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City DECATUR
Zip Code 30033

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Dataset Information

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.

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