Provider Demographics
NPI:1558584649
Name:R MATTHEW KAMINS MD PC
Entity Type:Organization
Organization Name:R MATTHEW KAMINS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:R
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:KAMINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-599-1444
Mailing Address - Street 1:2480 BRIARCLIFF RD STE 6-233,
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329
Mailing Address - Country:US
Mailing Address - Phone:404-499-1444
Mailing Address - Fax:404-499-1444
Practice Address - Street 1:2480 BRIARCLIFF RD STE 6-233
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329
Practice Address - Country:US
Practice Address - Phone:404-499-1444
Practice Address - Fax:404-499-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA398322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F53511Medicare UPIN