Provider Demographics
NPI:1558374371
Name:MATE-KOLE, JOHN OPATA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:OPATA
Last Name:MATE-KOLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6500 STANDING BOY RD
Mailing Address - Street 2:UNIT 24
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-3331
Mailing Address - Country:US
Mailing Address - Phone:571-331-5310
Mailing Address - Fax:
Practice Address - Street 1:6500 STANDING BOY RD
Practice Address - Street 2:UNIT 24
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3331
Practice Address - Country:US
Practice Address - Phone:571-331-5310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056756208000000X
WI68235208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100073470Medicaid