Healthcare Provider Details

I. General information

NPI: 1578038337
Provider Name (Legal Business Name): BYRON TYRELL MATHIS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 WASHINGTON RD
EVANS GA
30809-5875
US

IV. Provider business mailing address

1021 SILVER BLUFF RD
AIKEN SC
29803-5879
US

V. Phone/Fax

Practice location:
  • Phone: 706-650-0111
  • Fax: 706-651-1882
Mailing address:
  • Phone: 803-648-0587
  • Fax: 803-648-9846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3107
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9011
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: