Provider Demographics
NPI:1164684205
Name:MATHIEU, PAUL K JR (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:K
Last Name:MATHIEU
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3780 EISENHOWER PKWY
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-0800
Mailing Address - Country:US
Mailing Address - Phone:478-633-5500
Mailing Address - Fax:478-784-3550
Practice Address - Street 1:3780 EISENHOWER PKWY
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-0800
Practice Address - Country:US
Practice Address - Phone:478-633-5500
Practice Address - Fax:478-784-3550
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA003028207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine