Healthcare Provider Details

I. General information

NPI: 1013272053
Provider Name (Legal Business Name): JONATHAN DOUGLAS MATLOCK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 AL HIGHWAY 69 ATTN: DR. MATLOCK
GUNTERSVILLE AL
35976-7140
US

IV. Provider business mailing address

8000 AL HIGHWAY 69 ATTN: DR. MATLOCK
GUNTERSVILLE AL
35976-7140
US

V. Phone/Fax

Practice location:
  • Phone: 256-571-8000
  • Fax:
Mailing address:
  • Phone: 256-571-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1491
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number1491
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: