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General NPI Number Information
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NPI Number | 1316965908
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Entity Type | Individual
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Provider Name | EDWIN KEITH MATTHEWS MD
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 10/01/2020
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Provider Practice Location Address
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Address Line | 2422 DANVILLE ROAD SUITE E
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City | DECATUR
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State | AL
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Zip | 35603
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Country | US
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Telephone | 256-355-9040
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Fax | 256-355-9048
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Provider Business Mailing Address
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Address Line | PO BOX 5750
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City | DECATUR
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State | AL
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Zip | 35601
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Country | US
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Telephone | 256-355-9040
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Fax | 256-355-9048
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25048
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 00025048
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License Number State | AL
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