Provider Demographics
NPI:1417318015
Name:MATRIX MOBILITY LLC
Entity Type:Organization
Organization Name:MATRIX MOBILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANT
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-941-3891
Mailing Address - Street 1:PO BOX 1678
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-6425
Mailing Address - Country:US
Mailing Address - Phone:678-941-3891
Mailing Address - Fax:678-264-0918
Practice Address - Street 1:165 EDGE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-9169
Practice Address - Country:US
Practice Address - Phone:678-941-3891
Practice Address - Fax:678-264-0918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14001981332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies