Provider Demographics
NPI:1245758077
Name:MOSUNJAC, MATKO
Entity Type:Individual
Prefix:
First Name:MATKO
Middle Name:
Last Name:MOSUNJAC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 BRIARCLIFF PL NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-4832
Mailing Address - Country:US
Mailing Address - Phone:678-799-1241
Mailing Address - Fax:
Practice Address - Street 1:2900 CHAMBLEE TUCKER RD.
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-3030
Practice Address - Country:US
Practice Address - Phone:678-799-1241
Practice Address - Fax:770-718-5873
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health