MEDICARE: DR. MATTHEW DEAN SOCKWELL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	036616	GA
2	207L00000X	Anesthesiology Physician	036616	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	217890	OTHER	GA	BCBSGA PROVIDER ID NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285635383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW DEAN SOCKWELL MD

Provider Business Mailing Address
First Line	:	PO BOX 1565
Second Line	:
City	:	DAHLONEGA
State	:	GA
Zip	:	30533-0027
Country	:	US
Telephone Number	:	706-867-4116
Fax Number	:	706-867-4120

Provider Business Practice Location Address
First Line	:	104 ANSLEY DR
Second Line	:
City	:	DAHLONEGA
State	:	GA
Zip	:	30533-1614
Country	:	US
Telephone Number	:	706-867-4116
Fax Number	:	706-867-4120

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	05/20/2021

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