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General NPI Number Information
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NPI Number | 1942865290
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Entity Type | Individual
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Provider Name | MATTHEW GOOD PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/02/2019
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 13314 HIGHWAY 144 STE C
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City | RICHMOND HILL
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State | GA
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Zip | 31324-7388
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Country | US
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Telephone | 129-102-0109
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Fax |
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Provider Business Mailing Address
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Address Line | 550 LONGLEAF DR
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City | RICHMOND HILL
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State | GA
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Zip | 31324-6815
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Country | US
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Telephone | 610-301-8206
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA060652
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA060652
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 11989
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License Number State | GA
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