Organization
MAT GEORGIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTOR ALFONSO (CEO)
(818) 212-4659
Entity
Organization
Contact information
Practice address
335 ROSELANE ST NW, SUITE 203, MARIETTA, GA 30060-7902
(818) 212-4659
Mailing address
1290 KENNESTONE CIR, SUITE A112, MARIETTA, GA 30066-6009
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
05/05/2016
Last updated
05/05/2016
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