Provider Demographics
NPI:1578870457
Name:MATTOX, JULIE GRINER (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:GRINER
Last Name:MATTOX
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MOHAWK STREET
Mailing Address - Street 2:STE E
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419
Mailing Address - Country:US
Mailing Address - Phone:912-925-0067
Mailing Address - Fax:912-925-2381
Practice Address - Street 1:900 MOHAWK STREET
Practice Address - Street 2:STE E
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419
Practice Address - Country:US
Practice Address - Phone:912-925-0067
Practice Address - Fax:912-925-2381
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9234658363LF0000X
GARN211306363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003100692AMedicaid
GA18662110950Medicare PIN