Organization
MATRIX MOBILITY & HEALTHCARE PRODUCTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHANT TYRONE PAYTON (PRESIDENT/OWNWER)
(770) 456-8018
Entity
Organization
Contact information
Practice address
125 COMMONS WAY, SUITE 203, VILLA RICA, GA 30180-7038
(770) 456-8018
(678) 228-1424
Mailing address
125 COMMONS WAY, SUITE 203, VILLA RICA, GA 30180-7038
(770) 456-8018
(678) 228-1424
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
441911409A
—
GA
01
—
52210310
BCBS
GA
Enumeration date
08/30/2006
Last updated
12/01/2011
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