Healthcare Provider Details

I. General information

NPI: 1992963839
Provider Name (Legal Business Name): MATTHEW PAUL ST. GEORGE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 E DOYLE ST
TOCCOA GA
30577-3006
US

IV. Provider business mailing address

278 E DOYLE ST
TOCCOA GA
30577-3006
US

V. Phone/Fax

Practice location:
  • Phone: 706-886-9439
  • Fax:
Mailing address:
  • Phone: 706-886-9439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2008014167
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: