Healthcare Provider Details

I. General information

NPI: 1669975447
Provider Name (Legal Business Name): MATTHEW PHILIP BUTTERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2018
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON ROAD NE BOX M7
ATLANTA GA
30322-3049
US

IV. Provider business mailing address

1045 FLORIDA HWY
ATMORE AL
36502-6709
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-6382
  • Fax:
Mailing address:
  • Phone: 970-227-5880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number163610
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number87973
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number87973
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: