Individual
CORWIN OSWALD DEMATTOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1637 ATLANTA HWY SUITE A, GRAYSON, GA 30017-3001
(678) 344-8268
Mailing address
1637 ATLANTA HWY SUITE A, GRAYSON, GA 30017-5942
(678) 344-8268
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
189365
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054674999
GEORGIA IDENTIFICATION CARD
GA
Enumeration date
04/02/2020
Last updated
12/02/2021
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