Provider Demographics
NPI:1578690384
Name:ROBERT L. MATHIS & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:ROBERT L. MATHIS & ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:770-956-1056
Mailing Address - Street 1:PO BOX 813386
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30081-8386
Mailing Address - Country:US
Mailing Address - Phone:770-956-1056
Mailing Address - Fax:770-944-8586
Practice Address - Street 1:1640 POWERS FERRY RD SE
Practice Address - Street 2:BUILDING 8 - SUITE 145
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5491
Practice Address - Country:US
Practice Address - Phone:770-956-1056
Practice Address - Fax:770-944-8586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0021571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty