NPI age
6 years
Enumerated 2020-04-09
● Active
Type 1 · Individual
Matthew Charles Revilla, PA-C
Revilla is 1 of 2 physician assistant providers in Palmetto and 1 of 4616 in Georgia.
Primary specialty
Physician Assistant
Plus 1 subspecialty
Licensed in
GA
1 state
Status
Active
No deactivations on record
Last NPPES update
2021-08-27
Source: monthly bulk 2026-05
Sole proprietor
Yes
Solo practice on file
How this provider compares
Across 4616 active physician assistant providers in Georgia.
NPI age
6 years
↓ 2 yr below median (8 yr)
State licenses
1 state
9% of peers hold multiple states
Subspecialties
1
In the 24% of peers with subspecialties
NPI lifetime · 2020 → 2026
2020-04Enumerated in NPPES
2020
2026
Where they practice
Practice location
507 Park St
Palmetto, GA 302681007
Mailing address
643 Main St
Palmetto, GA 302681138
Additional practice locations
1 secondary location on file with NPPES.
Location 2
2584 Patrick Ct Se
Atlanta, GA 303173023
Specialties
-
Physician Assistant PrimaryA physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally...
-
Family MedicineThe NUCC recommends this code not be used. Choose a more appropriate code.
Practice context
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Check the state license is currently active.State licensing boards publish current status; NPPES does not.
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