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KENNESAW MOUNTAIN MEDICAL GROUP
NPI 1235378324
Clinic/Center - Primary Care in Kennesaw, GA

Active since February 12, 2009CLIA 11D1099359 · Waiver
1600 KENNESAW DUE WEST RD NW, BUILDING 600 SUITE 625, KENNESAW, GA 30152(770) 422-5880 Get Directions Write a Review

NPPES record last updated: February 12, 2009. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kennesaw Mountain Medical Group NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENNESAW MOUNTAIN MEDICAL GROUP (NPI 1235378324) is a healthcare organization registered as a primary care in Kennesaw, Georgia and active in the NPI registry since February 2009. The organization holds a CLIA Waiver certificate valid through May 11, 2027 and lists Gregory J Matechak, Physician, as its authorized official.

NPPES Registry Identity

NPI1235378324
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameKENNESAW MOUNTAIN MEDICAL GROUP
Location Address1600 KENNESAW DUE WEST RD NW, BUILDING 600 SUITE 625Kennesaw, GA 30152-4301
Mailing Address1600 Kennesaw Due West Rd Nw, Building 600 Suite 625Kennesaw, GA 30152-4301 · (770) 422-5880
Phone(770) 422-5880
Organization SubpartNo
Authorized OfficialGregory J MatechakPhysician · (770) 422-5880
Enumeration DateFebruary 12, 2009
✔ NPI 1235378324 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
License✔ Licensed in GA · 52992
1600 KENNESAW DUE WEST RD NW, Kennesaw, GA 30152
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D1099359

Kennesaw Mountain Medical Grap · Kennesaw, GA
Active · expires May 11, 2027
CLIA Number11D1099359
Laboratory TypePhysician Office
Certificate Effective DateMay 12, 2025
Certificate Expiration DateMay 11, 2027
Laboratory DirectorGregory J. Matechak
Laboratory Phone(770) 422-5880
Laboratory LocationKennesaw Mountain Medical Grap1600 Kennesaw Due West Building 600 Suite 625, Kennesaw, GA 30152
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HALLMARK DENTAL, LLC
Dentist (General Practice)
1600 KENNESAW DUE WEST RD NW, 305-306
KENNESAW, GA 30152
Cobb County (678) 355-0222
JOHN PALMER LANIER M.D.
Physical Medicine & Rehabilitation
1600 KENNESAW DUE WEST RD NW, SUITE 501
KENNESAW, GA 30152
Cobb County (770) 429-5555
DUE WEST INTEGRATED HEALTH CENTER PHYSICAL MEDICINE, LLC
Physical Medicine & Rehabilitation
1600 KENNESAW DUE WEST RD NW, SUITE 501
KENNESAW, GA 30152
Cobb County (770) 429-5555
DR. JOSEPH N GRISE D.C.
Chiropractor
1600 KENNESAW DUE WEST RD NW, STE 501
KENNESAW, GA 30152
Cobb County (770) 429-5555
PARK ROBERT MITCHELL, M.D.
Obstetrics & Gynecology (Gynecology)
1600 KENNESAW DUE WEST RD NW, STE 620
KENNESAW, GA 30152
Cobb County (770) 427-0171

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kennesaw Mountain Medical Group's NPI number?

The NPI number for Kennesaw Mountain Medical Group is 1235378324. It was assigned to this organization in the NPPES registry on February 12, 2009.

Where is Kennesaw Mountain Medical Group located?

Kennesaw Mountain Medical Group is located at 1600 Kennesaw Due West Rd NW Building 600 Suite 625, Kennesaw, GA 30152. The listed phone number is (770) 422-5880.

What is Kennesaw Mountain Medical Group's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Does Kennesaw Mountain Medical Group hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D1099359) is associated with this NPI, valid through May 11, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Kennesaw Mountain Medical Group was last updated on February 12, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.