MEDICARE: M.D.MATTHEWS CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347B00000X	Bus		GA

General Provider Information

NPI Number	:	1225067952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M.D.MATTHEWS CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 92446
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30314-0446
Country	:	US
Telephone Number	:	404-559-3425
Fax Number	:	404-559-1990

Provider Business Practice Location Address
First Line	:	2027 METROPOLITAN PKWY SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-5926
Country	:	US
Telephone Number	:	404-559-3435
Fax Number	:	404-559-1990

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MATHEW WAYNE WHITEST
Credential	:	M.D.
Telephone Number	:	404-559-3435

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	08/22/2020

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