Provider Demographics
NPI:1962957241
Name:CASON, MATTHEW LYLE
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LYLE
Last Name:CASON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 TIGER RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:GA
Mailing Address - Zip Code:31092-8138
Mailing Address - Country:US
Mailing Address - Phone:478-244-5856
Mailing Address - Fax:
Practice Address - Street 1:5775 PEACHTREE DUNWOODY RD
Practice Address - Street 2:C 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1556
Practice Address - Country:US
Practice Address - Phone:678-426-2930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7944363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant