1609744028 NPI number — MARIETTA PSYCHIATRY ASSOCIATES PC

Table of content: MATTHEW RON ANDERSON D.M.D. (NPI 1710243688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609744028 NPI number — MARIETTA PSYCHIATRY ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIETTA PSYCHIATRY ASSOCIATES PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609744028
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3597 REMBRANDT RD NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30327-2657
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-678-7034
Provider Business Mailing Address Fax Number:
770-678-7035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
670 NORTH AVE NW STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30060-1100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-678-7034
Provider Business Practice Location Address Fax Number:
770-678-7035
Provider Enumeration Date:
10/27/2025

Additional Information

Authorized Official

Authorized Official Last Name:
ABUBAKER
Authorized Official First Name:
ROOHI
Authorized Official Middle Name:
Authorized Official Title or Position:
MD / OWNER
Authorized Official Telephone Number:
404-218-8555

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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