Individual provider Active NPI

Matilda Besong, CRNA

  • Certified Registered Nurse Anesthetist
  • Columbus, GA
National Provider Identifier
1639399173
Registry record updated Oct 6, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN106732 Issued in GA
Practice address
616 19TH St
Columbus, GA 31901-1528
Phone
(706) 494-4262
NPI assigned
Apr 26, 2007
Last updated
Oct 6, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X RN106732 GA Primary

Addresses

Primary practice location

616 19TH St
Columbus, GA 31901-1528

Mailing address

4095 Soaring Dr
Douglasville, GA 30135-7459
Phone (205) 317-6175

Other identifiers 2

IdentifierTypeStateIssuer
244006770BMedicaidGA
244006770AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071207000683 GA Practitioner - Certified Registered Nurse Anesthetist (Crna) 3971692336 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
University of Alabama School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3292 Mountain Dr
Decatur, GA 30032-1102
Phone (404) 294-8180

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN106732GAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
GSG Anesthesia, LLC CurrentSince Feb 1, 2023 Accepting new patients
Progressive Anesthesia LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 2013 Accepting new patients
GSD Anesthesia Providers, LLC CurrentSince May 1, 2020 Accepting new patients
Greater Atlanta Anesthesia, LLC CurrentSince Feb 1, 2023 Accepting new patients
Northern Georgia Anesthesia Associates, LLC Nurse Anesthetist, Certified Registered CurrentSince May 20, 2025 Accepting new patients
WGG Anesthesia, LLC Nurse Anesthetist, Certified Registered CurrentSince Feb 1, 2023 Accepting new patients
JC Anesthesia LLC CurrentSince Oct 1, 2022 Accepting new patients
Amsol Anesthetists of Georgia, LLC Nurse Anesthetist, Certified Registered Past Accepting new patients
Carolina Anesthesia Associates PA Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

3280 Howell Mill Rd NW
Ste T150
Atlanta, GA 30327
Phone (404) 355-3200

95 Collier Rd NW
Ste 4075
Atlanta, GA 30309
Phone (404) 355-2200

160 Clinic Ave
Carrollton, GA 30117
Phone (770) 214-2800

3292 Mountain Dr
Decatur, GA 30032
Phone (404) 294-8180

3292 Mountain Dr
Ste A
Decatur, GA 30032
Phone (404) 294-8180

1265 Highway 54 W
Ste 401
Fayetteville, GA 30214
Phone (678) 617-6505

134 Mountainside Village Pkwy
Bldg 500
Jasper, GA 30143
Phone (706) 253-7340

721 Wellness Way
Ste 110
Lawrenceville, GA 30046
Phone (770) 995-7923

5669 Ptree Dunwoody Rd NE
Ste 210
Sandy Springs, GA 30342
Phone (404) 255-4333

1090 Experiment Station Rd
Unit 529
Watkinsville, GA 30677
Phone (706) 621-4108

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191628800000",
    "number": "1639399173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4095 SOARING DR",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301357459",
            "telephone_number": "205-317-6175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 19TH ST",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319011528",
            "telephone_number": "706-494-4262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BESONG",
        "first_name": "MATILDA",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-26",
        "last_updated": "2007-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "GA",
            "license": "RN106732",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "244006770B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "244006770A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.