Individual
GEORGE KORAH MATTAMANA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4881 SUGAR MAPLE DR, 88MDG/SGHJ, WRIGHT PATTERSON AFB, OH 45433-5546
(937) 829-9033
Mailing address
1655 ASHMONT CT, XENIA, OH 45385-7060
(937) 829-9033
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2005020681
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
COA.10047-NA
OH
Other
Enumeration date
01/31/2008
Last updated
06/01/2013
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