Healthcare Provider Details

I. General information

NPI: 1912050113
Provider Name (Legal Business Name): MATTHEW PATRICK LINK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 13TH ST SUITE 20
AUGUSTA GA
30901-2700
US

IV. Provider business mailing address

811 13TH ST SUITE 20
AUGUSTA GA
30901-2700
US

V. Phone/Fax

Practice location:
  • Phone: 706-722-3401
  • Fax: 706-724-6540
Mailing address:
  • Phone: 706-722-3401
  • Fax: 706-724-6540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number058695
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: