Healthcare Provider Details

I. General information

NPI: 1225067952
Provider Name (Legal Business Name): M.D.MATTHEWS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2027 METROPOLITAN PKWY SW
ATLANTA GA
30315-5926
US

IV. Provider business mailing address

PO BOX 92446
ATLANTA GA
30314-0446
US

V. Phone/Fax

Practice location:
  • Phone: 404-559-3435
  • Fax: 404-559-1990
Mailing address:
  • Phone: 404-559-3425
  • Fax: 404-559-1990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number StateGA

VIII. Authorized Official

Name: DR. MATHEW WAYNE WHITEST
Title or Position: PRESIDENT
Credential: M.D.
Phone: 404-559-3435