Provider Demographics
NPI:1770230997
Name:MATTER HEALTH OF GEORGIA, LLC
Entity Type:Organization
Organization Name:MATTER HEALTH OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-306-0996
Mailing Address - Street 1:1131 4TH AVE S STE 210
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-2737
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1900 PERRY BLVD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-3500
Practice Address - Country:US
Practice Address - Phone:470-890-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-08
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003283339AMedicaid