Provider Demographics
NPI:1194363366
Name:MATTHEWS, CLARA A (BSN,RN, CSFA)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:A
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:BSN,RN, CSFA
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Mailing Address - Street 1:863 FLAT SHOALS RD SE
Mailing Address - Street 2:SUITE C #376
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-6633
Mailing Address - Country:US
Mailing Address - Phone:717-324-0667
Mailing Address - Fax:
Practice Address - Street 1:1930 WINDSOR CREEK DRIVE SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094
Practice Address - Country:US
Practice Address - Phone:717-324-0667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363AS0400X
GA193351363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical