Organization
B MATA LLC
Active
Other names
Centro Medico San Lucas
Organization subpart
No
Provider details
NPI number
Authorized official
BYRON OSWALDO MATA GONZALEZ MD (OWNER)
(786) 427-4450
Entity
Organization
Contact information
Practice address
1631 ATLANTA HWY, GAINESVILLE, GA 30504-5942
(770) 718-1517
(770) 718-1518
Mailing address
1631 ATLANTA HWY, GAINESVILLE, GA 30504-5942
(770) 718-1517
(770) 718-1518
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
01/28/2020
Last updated
01/28/2020
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