Healthcare Provider Details

I. General information

NPI: 1285635383
Provider Name (Legal Business Name): MATTHEW DEAN SOCKWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 ANSLEY DR
DAHLONEGA GA
30533-1614
US

IV. Provider business mailing address

PO BOX 1565
DAHLONEGA GA
30533-0027
US

V. Phone/Fax

Practice location:
  • Phone: 706-867-4116
  • Fax: 706-867-4120
Mailing address:
  • Phone: 706-867-4116
  • Fax: 706-867-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036616
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036616
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: