Provider Demographics
NPI:1093107799
Name:MATTHEWS, ANJHARI (NP)
Entity Type:Individual
Prefix:
First Name:ANJHARI
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:ANJHARI
Other - Middle Name:JULIEN
Other - Last Name:BATIESTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:643 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:GA
Mailing Address - Zip Code:30268-1138
Mailing Address - Country:US
Mailing Address - Phone:404-929-8824
Mailing Address - Fax:404-929-9769
Practice Address - Street 1:202 CROFT ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117
Practice Address - Country:US
Practice Address - Phone:770-834-2255
Practice Address - Fax:770-834-7100
Is Sole Proprietor?:No
Enumeration Date:2015-03-04
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07779363LC1500X
GA258990363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003204866AMedicaid