Healthcare Provider Details

I. General information

NPI: 1659404887
Provider Name (Legal Business Name): MS. CYNTHIA JEANNETTE MATTHEWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 CHURCH ST NE SUITE 410
MARIETTA GA
30060-7282
US

IV. Provider business mailing address

4290 COUNTRY GARDEN WALK NW
KENNESAW GA
30152-2395
US

V. Phone/Fax

Practice location:
  • Phone: 770-422-1988
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN091606
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: