Provider Demographics
NPI:1184858292
Name:HAZZARD, MATTHEW AARON (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:AARON
Last Name:HAZZARD
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 1:631 PROFESSIONAL DR STE 360
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3370
Mailing Address - Country:US
Mailing Address - Phone:678-312-2700
Mailing Address - Fax:
Practice Address - Street 1:631 PROFESSIONAL DR STE 360
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3370
Practice Address - Country:US
Practice Address - Phone:678-312-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA074233207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003161954DMedicaid
GA003161954AMedicaid
GA003161954CMedicaid
GA8284544OtherCIGNA
GA003161954EMedicaid
GA003161954BMedicaid
GA003161954FMedicaid
GA1143430OtherWELLCARE
GA03225408OtherAMERIGROUP