Provider Demographics
NPI:1659983856
Name:MATHIAS, EMILIE CARSELL (DNP)
Entity Type:Individual
Prefix:DR
First Name:EMILIE
Middle Name:CARSELL
Last Name:MATHIAS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 N CROSSING WAY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-4175
Mailing Address - Country:US
Mailing Address - Phone:413-446-8016
Mailing Address - Fax:
Practice Address - Street 1:2208 N CROSSING WAY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4175
Practice Address - Country:US
Practice Address - Phone:413-446-8016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN286163363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily