Healthcare Provider Details

I. General information

NPI: 1114363926
Provider Name (Legal Business Name): MRS. RHONDA MATTHEWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2013
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1649 US HWY 52
SCRANTON SC
29591-0129
US

IV. Provider business mailing address

1649 HIGHWAY 52
SCRANTON SC
29591-0129
US

V. Phone/Fax

Practice location:
  • Phone: 843-389-2531
  • Fax: 843-389-2548
Mailing address:
  • Phone: 843-389-2531
  • Fax: 843-389-2548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number61193
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: