Provider Demographics
NPI:1851942841
Name:MATTIE & ASSOCIATES
Entity Type:Organization
Organization Name:MATTIE & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:CCS, CMRS
Authorized Official - Phone:877-899-2709
Mailing Address - Street 1:1010 VILLA DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-8722
Mailing Address - Country:US
Mailing Address - Phone:877-899-2709
Mailing Address - Fax:
Practice Address - Street 1:2900 WESTFORK DR STE 401
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70827-0004
Practice Address - Country:US
Practice Address - Phone:877-899-2709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MATTIE & ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-22
Last Update Date:2019-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty