Healthcare Provider Details

I. General information

NPI: 1669491007
Provider Name (Legal Business Name): MATTHEW C. ELDER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 PRINCE AVE
ATHENS GA
30606-6004
US

IV. Provider business mailing address

2300 PRINCE AVE
ATHENS GA
30606-6004
US

V. Phone/Fax

Practice location:
  • Phone: 706-543-4717
  • Fax:
Mailing address:
  • Phone: 706-543-4717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN011543
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: