Provider Demographics
NPI:1043341043
Name:MATHEWS, SHAWN BELL (MD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:BELL
Last Name:MATHEWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MEDICAL DR STE 705
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4130
Mailing Address - Country:US
Mailing Address - Phone:706-803-7960
Mailing Address - Fax:
Practice Address - Street 1:300 MEDICAL DR STE 705
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4130
Practice Address - Country:US
Practice Address - Phone:706-803-7960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA079724207Y00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0728210OtherBLUE CROSS BLUE SHIELD
AZ755879Medicaid
AZH34704Medicare UPIN
AZ116436Medicare PIN