Provider Demographics
NPI:1902915408
Name:MATHERS, MICHAEL JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JONATHAN
Last Name:MATHERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:M. JONATHAN
Other - Middle Name:
Other - Last Name:MATHERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:900 CIRCLE 75 PKWY SE
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3035
Mailing Address - Country:US
Mailing Address - Phone:770-953-6929
Mailing Address - Fax:770-953-6972
Practice Address - Street 1:105 COLLIER RD NW
Practice Address - Street 2:SUITE 2000
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1710
Practice Address - Country:US
Practice Address - Phone:404-352-1053
Practice Address - Fax:404-350-0840
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055416207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA602909709MMedicaid
GA003137262AMedicaid
GAI18718Medicare UPIN
GA202I203358Medicare PIN