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NPI Code Detail

MEDICARE: COREY MATHEWSON

MEDICARE: COREY MATHEWSON
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1477417269
Entity Type Code : Individual
Provider Name (Legal Business Name) : COREY MATHEWSON
Provider Business Mailing Address
First Line : 2805 S INDUSTRIAL HWY STE 100
Second Line :
City : ANN ARBOR
State : MI
Zip : 48104-6791
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 24 JOE KENNEDY BLVD STE 13
Second Line :
City : STATESBORO
State : GA
Zip : 30458-3113
Country : US
Telephone Number : 912-208-2024
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2025
Last Update Date : 12/15/2025

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Directions to “ COREY MATHEWSON ” Practice Location

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