Provider Demographics
NPI:1942944988
Name:FULL STEAM AHEAD MENTAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:FULL STEAM AHEAD MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GIDEON
Authorized Official - Middle Name:
Authorized Official - Last Name:MATZKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:470-589-5858
Mailing Address - Street 1:1 GLENLAKE PKWY STE 700
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3496
Mailing Address - Country:US
Mailing Address - Phone:470-589-5858
Mailing Address - Fax:
Practice Address - Street 1:1521 JOHNSON FERRY RD STE 100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6404
Practice Address - Country:US
Practice Address - Phone:470-589-5858
Practice Address - Fax:470-589-4040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty