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NPI Code Detail

MEDICARE: MATTHEW W ARD PA-C

MEDICARE: MATTHEW W ARD PA-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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1972797322
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW W ARD PA-C
Provider Business Mailing Address
First Line : 204 N WESTOVER BLVD
Second Line :
City : ALBANY
State : GA
Zip : 31707-2983
Country : US
Telephone Number : 229-888-6559
Fax Number :
Provider Business Practice Location Address
First Line : 1300 NEWTON RD
Second Line :
City : ALBANY
State : GA
Zip : 31701-3424
Country : US
Telephone Number : 229-431-3120
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2007
Last Update Date : 02/17/2014

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