Search › Georgia › 363A00000X
Matthew Revilla, PA-C
NPI 1821617036 · on the registry since 2020 · sole proprietor
Practice
- Address
- 507 Park St
Palmetto, GA 30268 - Phone
- (770) 463-4644
- Organisation at this address
- Palmetto Health Council, Inc.
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 4
Additional practice sites
- 2584 Patrick Ct Se, Atlanta, GA
Registry record
- Primary taxonomy
- 363A00000X
363A00000X
- Also registered as
- 207QA0505X
- Licence states on file
- GA
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2021-08-27
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Georgia