Provider Demographics
NPI:1821799040
Name:STENZEL, MATTHEW (NP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:STENZEL
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 SPRINGROCK DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-2172
Mailing Address - Country:US
Mailing Address - Phone:404-558-3716
Mailing Address - Fax:
Practice Address - Street 1:1780 PEACHTREE PKWY STE 302
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6834
Practice Address - Country:US
Practice Address - Phone:770-772-1830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA258854363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily