Healthcare Provider Details

I. General information

NPI: 1487518544
Provider Name (Legal Business Name): CAREY CAMPBELL MATHURIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 HWY 78 SUITE 103
LOGANVILLE GA
30052
US

IV. Provider business mailing address

1770 EISENHOWER AVE
BOGART GA
30622-8321
US

V. Phone/Fax

Practice location:
  • Phone: 470-375-2196
  • Fax:
Mailing address:
  • Phone: 706-372-6258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADS001144
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: