Revilla, Matthew Charles

Revilla, Matthew Charles is an sole proprietor health care provider with primary practice located at 507 Park St , Palmetto GA 30268-1007. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Adult Medicine, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Revilla, Matthew Charles can be contacted via phone (770) 463-4644.

Contact Information

Primary practice address
507 Park St Palmetto GA 30268-1007
Phone: (770) 463-4644
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Adult Medicine 207QA0505X 9684 Georgia
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 9684 Georgia

Profile Details

NPI number 1821617036
LBN Legal business name Revilla, Matthew Charles
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 9th, 2020
Last updated Aug 27th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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