Jill Rae Mattingly, PA-C, MMSC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

3283 Issued in GA

Practice address

4500 Hugh Howell Rd
Suite 340
Tucker, GA 30084-4723

Phone

(678) 534-1715

NPI assigned

May 4, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Mahon Family Medicine

  • Family Medicine Physician
  • Snellville, GA
  • NPI 1629318035
  Medicare reassignment

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770795361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "586 MOUNTAIN PARK TRL",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300875709",
            "telephone_number": "770-469-6903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 HUGH HOWELL RD",
            "address_2": "SUITE 340",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844723",
            "telephone_number": "678-534-1715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTINGLY",
        "first_name": "JILL",
        "middle_name": "RAE",
        "credential": "PA-C, MMSC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "3283",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Masvida Health Care Solutions, LLC
• Matias Health Chiropractic II LLC
• Matrix Rehabilitation-Georgia Inc (Physiotherapy Associates)
• Mary Natsai Matshoba, NP
• Sandra Matthews
• Pamela May, P.T.
• Kaleigh McAfee
• Samuel Nathaniel McAllister, M.D.
• William Hiroshi McAneny, FNP
• Marcia F. McBrayer, CFNP

• Physician Assistant in Tucker, GA
• Providers in Tucker, GA by specialty
• Physician Assistant in Georgia

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.