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Corwin Oswald Demattos
Family Nurse Practitioner in Grayson, Georgia
NPI 1720617756

Corwin Oswald Demattos is a Family Nurse Practitioner based in Grayson, GA and is specialized in Family. Corwin Oswald Demattos practices in Grayson, GA. The NPI Number for Corwin Oswald Demattos is 1720617756 and holds a License No. 189365 (Georgia).

The current practice location address for Corwin Oswald Demattos is 1637 Atlanta Hwy Suite A, Grayson, GA and can be reached out via phone at 678-344-8268.

Location: 1637 Atlanta Hwy Suite A, Grayson, GA, 30017-5942
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1720617756
Provider Name
Corwin Oswald Demattos
Credential
Provider Entity Type
Individual
Gender
Male
Address
1637 Atlanta Hwy Suite A, Grayson, GA, 30017-5942
Phone Number
678-344-8268
Fax Number
Provider Enumeration Date
04/02/2020
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
054674999 01 GA GEORGIA IDENTIFICATION CARD
institution
Provider Business Practice Location Address Details
Address
1637 Atlanta Hwy Suite A
City
Grayson
State
Georgia
Zip
30017-3001
Phone Number
678-344-8268
Fax Number
person
Provider Business Mailing Address Details
Address
1637 Atlanta Hwy Suite A
City
Grayson
State
Georgia
Zip
30017-3001
Phone Number
678-344-8268
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
363LF0000X
License No.
189365 (Georgia)
Definition
Definition to come...
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