Active NPI
Matthew Panetta
- Athletic Trainer
- Milledgeville, GA
National Provider Identifier
1407320302
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 231 W Hancock St
Milledgeville, GA 31061-3375 - Phone
- (770) 757-7856
- NPI assigned
- Jan 15, 2019
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Primary |
Addresses
Primary practice location
231 W Hancock St
Milledgeville, GA 31061-3375
Mailing address
6510 Pine Ridge Cir
Cumming, GA 30041-4728
Phone (770) 757-7856
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 954378970 | Other | GA | UNITED HEALTHCARE |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1547510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1547510400000",
"number": "1407320302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6510 PINE RIDGE CIR",
"city": "CUMMING",
"state": "GA",
"postal_code": "300414728",
"telephone_number": "770-757-7856"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "231 W HANCOCK ST",
"city": "MILLEDGEVILLE",
"state": "GA",
"postal_code": "310613375",
"telephone_number": "770-757-7856"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PANETTA",
"first_name": "MATTHEW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-01-15",
"last_updated": "2019-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "954378970",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milledgeville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.