Provider Demographics
NPI:1184473951
Name:MATHIAS, CHI T TIANNE
Entity type:Individual
Prefix:
First Name:CHI T
Middle Name:TIANNE
Last Name:MATHIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 BUICE LAKE PKWY APT 8308
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-8433
Mailing Address - Country:US
Mailing Address - Phone:404-451-2011
Mailing Address - Fax:
Practice Address - Street 1:419 E CROSSVILLE RD STE 104
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3000
Practice Address - Country:US
Practice Address - Phone:404-451-2011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula