Healthcare Provider Details

I. General information

NPI: 1235303314
Provider Name (Legal Business Name): MATTHEW M. MONDI, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 HARPER ST BUILDING B
AUGUSTA GA
30901-0617
US

IV. Provider business mailing address

1430 HARPER ST BUILDING B
AUGUSTA GA
30901-0617
US

V. Phone/Fax

Practice location:
  • Phone: 706-724-5451
  • Fax:
Mailing address:
  • Phone: 706-724-5451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW M MONDI
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: M.D.
Phone: 706-724-5451