Healthcare Provider Details

I. General information

NPI: 1497016778
Provider Name (Legal Business Name): ADAM R MATHES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PIEDMONT SPINE AND NEUROSURGICAL GROUP 3 ST. FRANCIS DRIVE, STE 490
GREENVILLE SC
29601-3973
US

IV. Provider business mailing address

PO BOX 743294
ATLANTA GA
30374-3294
US

V. Phone/Fax

Practice location:
  • Phone: 864-220-4263
  • Fax: 877-817-1865
Mailing address:
  • Phone: 336-716-2674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number52056
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: