Individual
DR. CARL G MATTACOLA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
900 SOUTH LIMESTONE, LEXINGTON, KY 40536-0001
(859) 323-1100
(859) 323-6003
Mailing address
INDIGO FARM, 2282 DANVILLE ROAD, HARRODSBURG, KY 40330
(859) 323-1100
(859) 323-6003
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
AT 400
KY
246Z00000X
Other Specialist/Technologist
Primary
AT400
KY
Other
Enumeration date
02/07/2006
Last updated
07/08/2007
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