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General NPI Number Information
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NPI Number | 1043341043
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Entity Type | Individual
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Provider Name | SHAWN BELL MATHEWS M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 04/01/2024
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Provider Practice Location Address
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Address Line | 300 MEDICAL DR STE 705
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City | LAGRANGE
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State | GA
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Zip | 30240-4130
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Country | US
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Telephone | 706-803-7960
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Fax |
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Provider Business Mailing Address
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Address Line | 300 MEDICAL DR STE 705
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City | LAGRANGE
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State | GA
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Zip | 30240-4130
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Country | US
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Telephone | 706-803-7960
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 079724
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License Number State | GA
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