Provider Demographics
NPI:1467637538
Name:MATTHEW J. NOVAK, MD, P.C.
Entity Type:Organization
Organization Name:MATTHEW J. NOVAK, MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-794-1995
Mailing Address - Street 1:50 BARRETT PKWY
Mailing Address - Street 2:SUITE 1200, # 338
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3300
Mailing Address - Country:US
Mailing Address - Phone:770-794-1995
Mailing Address - Fax:770-794-1996
Practice Address - Street 1:780 CANTON RD NE
Practice Address - Street 2:SUITE 320
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7241
Practice Address - Country:US
Practice Address - Phone:770-794-1995
Practice Address - Fax:770-794-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048552174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00899258AMedicaid
GA020048465OtherRAILROAD MEDICARE
GA511G700333Medicare PIN
GA020048465OtherRAILROAD MEDICARE