Active NPI
Matthew Edwin Davis, M.D.
- Otolaryngology Physician
- Riverdale, GA
National Provider Identifier
1225105489
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 016052
- Practice address
- 33 Upper Riverdale Rd SW
Suite 117
Riverdale, GA 30274-2626 - Phone
- (770) 991-1170
- Fax
- (770) 991-0107
- NPI assigned
- Nov 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 016052 | GA | Primary |
Addresses
Primary practice location
33 Upper Riverdale Rd SW
Suite 117
Riverdale, GA 30274-2626
Mailing address
33 Upper Riverdale Rd SW
Suite 117
Riverdale, GA 30274-2626
Phone (770) 991-1170
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00065403B | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Robin Alverson Inc | Past | Accepting new patients | |
| Emory Medical Care Foundation Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Diagnostic Radiology Physician
- Atlanta, GA
- NPI 1225294739
-
- Audiologist
- Riverdale, GA
- NPI 1215341375
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1225105489",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33 UPPER RIVERDALE RD SW",
"address_2": "SUITE 117",
"city": "RIVERDALE",
"state": "GA",
"postal_code": "302742626",
"telephone_number": "770-991-1170",
"fax_number": "770-991-0107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "33 UPPER RIVERDALE RD SW",
"address_2": "SUITE 117",
"city": "RIVERDALE",
"state": "GA",
"postal_code": "302742626",
"telephone_number": "770-991-1170",
"fax_number": "770-991-0107"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "MATTHEW",
"middle_name": "EDWIN",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "GA",
"license": "016052",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00065403B",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Riverdale, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.