Provider Demographics
NPI:1215220454
Name:HUGHES, MATTHEW PRESTON (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:PRESTON
Last Name:HUGHES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:835 COGBURN AVE NW
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1001
Mailing Address - Country:US
Mailing Address - Phone:770-422-8815
Mailing Address - Fax:770-422-8816
Practice Address - Street 1:835 COGBURN AVE NW
Practice Address - Street 2:SUITE 250
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1001
Practice Address - Country:US
Practice Address - Phone:770-422-8815
Practice Address - Fax:770-422-8816
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA73538207N00000X, 207ND0101X
KY47896207ND0101X, 207NS0135X
390200000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I072312Medicare Oscar/Certification