# K-MATA LLC

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

## Provider details

- **NPI number:** 1790655108
- **Authorized official:** BYRON OSWALDO MATA GONZALEZ MD (PRESIDENT)
- **Authorized official phone:** (770) 718-1517

## Contact information

- **Practice address:** 4292 CHAMBLEE TUCKER RD, TUCKER, GA 30084-2103
- **Practice address phone:** (770) 718-1517
- **Practice address fax:** (770) 718-1518
- **Mailing address:** 3899 GRASSLAND LOOP, LAKE MARY, FL 32746-4120
- **Mailing address phone:** (770) 718-1517
- **Mailing address fax:** (770) 718-1518

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/10/2025
- **Last updated:** 11/10/2025