MEDICARE: CHERLYN MITZI MATTHEWS NP-C

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	363LF0000X	Family Nurse Practitioner	RN118570	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN118570	OTHER	GA	APRN LICENSE NUMBER

General Provider Information

NPI Number	:	1871634113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERLYN MITZI MATTHEWS NP-C

Provider Business Mailing Address
First Line	:	250 MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31201-3490
Country	:	US
Telephone Number	:	478-301-2362
Fax Number	:	478-301-2272

Provider Business Practice Location Address
First Line	:	400 POPLAR ST
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31201-3336
Country	:	US
Telephone Number	:	478-787-4266
Fax Number	:	478-787-4199

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	07/02/2024

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