Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jaiba Paul Mathew, AGACNP-BC

Individual provider Adult Health Nurse Practitioner · NPI 1669090460

Jaiba Paul Mathew, AGACNP-BC is a Nurse Practitioner in Atlanta, Georgia. Qualified in 2019, 7 years ago. Practices with The Southeast Permanente Medical Group, a 826-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
7
Licensed in
GA
In the registry since
2020
Specialties on file
2
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Practice location Address checks out

980 Johnson Fy Rd NE
Atlanta, GA 30342-1626
Phone: (404) 252-0256
Fax: (404) 252-0256
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 5665 Peachtree Dunwoody, Atlanta, GA 30342-1764 — (678) 843-7001

Specialties & licences

Acute Care Nurse Practitioner (primary) Taxonomy 363LA2100X · Licence RN207189 (GA)
Adult Health Nurse Practitioner Taxonomy 363LA2200X · Licence RN207189 (GA)

Record details

NPI number1669090460
Entity typeIndividual (Type 1)
GenderFemale
Credentials AGACNP-BC
Sole proprietorNo
NPI enumeratedJuly 8, 2020
Last updated in NPPESJuly 8, 2020
Certification dateJuly 8, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice The Southeast Permanente Medical Group — 826 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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