Basic Information
| Provider Information | |||||||||
| NPI: | 1851492672 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATECHAK | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 E 2ND AVE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | ROME | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301613209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065093278 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1650 CHATTAHOOCHEE DR | ||||||||
| Address2: | |||||||||
| City: | ROCKMART | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301532023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706846100 | ||||||||
| FaxNumber: | 7706847522 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 05/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 52992 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.