Healthcare Provider Details

I. General information

NPI: 1508880873
Provider Name (Legal Business Name): JONATHAN C MCMATH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4355 HICKORY BLVD STE 2
GRANITE FALLS NC
28630-2014
US

IV. Provider business mailing address

321 MULBERRY ST SW MEDICAL STAFF SERVICES
LENOIR NC
28645-5720
US

V. Phone/Fax

Practice location:
  • Phone: 828-757-5050
  • Fax: 828-757-5051
Mailing address:
  • Phone: 828-757-5965
  • Fax: 828-757-5104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number201301476
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: