# MAT GEORGIA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356797666
- **Authorized official:** VICTOR ALFONSO (CEO)
- **Authorized official phone:** (818) 212-4659

## Contact information

- **Practice address:** 335 ROSELANE ST NW, SUITE 203, MARIETTA, GA 30060-7902
- **Practice address phone:** (818) 212-4659
- **Mailing address:** 1290 KENNESTONE CIR, SUITE A112, MARIETTA, GA 30066-6009

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | NULL | Yes |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/05/2016
- **Last updated:** 05/05/2016