Healthcare Provider Details

I. General information

NPI: 1215970777
Provider Name (Legal Business Name): MICHELLE ALLYSON MATTHEWS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 MERIDIAN PKWY STE 323
DURHAM NC
27713-4232
US

IV. Provider business mailing address

509 N ELAM AVE SUITE 3E
GREENSBORO NC
27403-1129
US

V. Phone/Fax

Practice location:
  • Phone: 984-227-8902
  • Fax:
Mailing address:
  • Phone: 336-832-1970
  • Fax: 336-832-1988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number200401537
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: