| K-mata LLC | |
|
4292 Chamblee Tucker Rd Tucker GA 30084-2103 | |
| (770) 718-1517 | |
| (770) 718-1518 |
| Full Name | K-mata LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 4292 Chamblee Tucker Rd, Tucker, Georgia |
| Authorized Official Name and Position | Byron Oswaldo Mata Gonzalez (PRESIDENT) |
| Authorized Official Contact | 7707181517 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| K-mata LLC 3899 Grassland Loop Lake Mary FL 32746-4120 Ph: (770) 718-1517 | K-mata LLC 4292 Chamblee Tucker Rd Tucker GA 30084-2103 Ph: (770) 718-1517 |
| NPI Number | 1790655108 |
|---|---|
| Provider Enumeration Date | 11/10/2025 |
| Last Update Date | 11/10/2025 |
| Certification Date | 11/10/2025 |
| Medicare PECOS PAC ID | 8123512092 |
|---|---|
| Medicare Enrollment ID | O20251209003141 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790655108 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Byron Mata Gonzalez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326206897 PECOS PAC ID: 8325180680 Enrollment ID: I20251210003019 |
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