Healthcare Provider Details

I. General information

NPI: 1699238717
Provider Name (Legal Business Name): CHELSEA MATTHIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHELSEA MONTGOMERY

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MEDICAL RIDGE DR
GREENVILLE SC
29605-4267
US

IV. Provider business mailing address

300 E MCBEE AVE STE 300
GREENVILLE SC
29601-2899
US

V. Phone/Fax

Practice location:
  • Phone: 864-522-5220
  • Fax: 864-522-5296
Mailing address:
  • Phone: 864-522-8611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME155798
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number94335
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: