Healthcare Provider Details

I. General information

NPI: 1447209937
Provider Name (Legal Business Name): MINEY MATHEWS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MINEY MATHEWS MD

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 CHARLES GILMAN JR AVE STE B
KINGSLAND GA
31548-5664
US

IV. Provider business mailing address

711 CHARLES GILMAN JR AVE STE B
KINGSLAND GA
31548-5664
US

V. Phone/Fax

Practice location:
  • Phone: 912-510-9728
  • Fax: 912-510-9752
Mailing address:
  • Phone: 912-510-9728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number84640
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: