Healthcare Provider Details

I. General information

NPI: 1083098867
Provider Name (Legal Business Name): FRANKLIN MATHIS MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2015
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 W PERSHING RD
DECATUR IL
62526-1537
US

IV. Provider business mailing address

833 W PERSHING RD
DECATUR IL
62526-1537
US

V. Phone/Fax

Practice location:
  • Phone: 217-454-0837
  • Fax:
Mailing address:
  • Phone: 217-454-0837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberNONE
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: