Basic Information
| Provider Information | |||||||||
| NPI: | 1215048442 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATTOX | ||||||||
| FirstName: | DOUGLAS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1365A CLIFTON RD NE | ||||||||
| Address2: | DEPARTMENT OF OTOLARYNGOLOGY - HEAD AND NECK SURGERY | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303221013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047783381 | ||||||||
| FaxNumber: | 4047784295 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 PEACHTREE ST NE DEPT OF | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303082247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047783381 | ||||||||
| FaxNumber: | 4047784295 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 07/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 45291 | GA | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207YX0901X | 45291 | GA | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Otology & Neurotology |
No ID Information.