Provider Demographics
NPI:1922156074
Name:MATHESON, CAROL ANN (PHD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:MATHESON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2970 PEACHTREE RD NW STE 110
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2110
Mailing Address - Country:US
Mailing Address - Phone:678-571-7320
Mailing Address - Fax:
Practice Address - Street 1:2970 PEACHTREE RD NW STE 110
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2110
Practice Address - Country:US
Practice Address - Phone:678-571-7320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2676103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent