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General NPI Number Information
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NPI Number | 1942561121
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Entity Type | Organization
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Legal Business Name | T. KEITH MATTHEWS, D.O.,P.C.
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Dates
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Enumeration Date | 06/04/2012
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Last Update Date | 05/13/2016
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Provider Practice Location Address
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Address Line | 56 APPALACHIAN AVE
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-2271
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Country | US
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Telephone | 706-781-3994
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Fax | 706-781-3997
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Provider Business Mailing Address
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Address Line | 56 APPALACHIAN AVE
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-2271
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Country | US
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Telephone | 706-781-3994
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Fax | 706-781-3997
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Authorized Official
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Title or Position | OWNER
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Name | DR. T KEITH MATTHEWS
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Credential | D.O.
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Telephone | 706-781-3994
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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 | 039632
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License Number State | GA
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