Provider Demographics
NPI:1003018714
Name:MATHIS, CJ (CFA)
Entity Type:Individual
Prefix:
First Name:CJ
Middle Name:
Last Name:MATHIS
Suffix:
Gender:F
Credentials:CFA
Other - Prefix:
Other - First Name:CJ
Other - Middle Name:
Other - Last Name:MATHIS-CHANDLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CFA
Mailing Address - Street 1:104 LAKESHORE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-3803
Mailing Address - Country:US
Mailing Address - Phone:912-673-1771
Mailing Address - Fax:
Practice Address - Street 1:104 LAKESHORE DR
Practice Address - Street 2:SUITE B
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3803
Practice Address - Country:US
Practice Address - Phone:912-673-1771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist