Healthcare Provider Details

I. General information

NPI: 1235482985
Provider Name (Legal Business Name): FELECIA MATHEWS MS RD CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 7TH AVE
COLUMBUS GA
31901-1563
US

IV. Provider business mailing address

5823 WILTSHIRE DR
COLUMBUS GA
31909-4747
US

V. Phone/Fax

Practice location:
  • Phone: 706-507-7067
  • Fax: 706-507-7068
Mailing address:
  • Phone: 706-718-5421
  • Fax: 706-322-7334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberLD000107
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number09520320
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: