Provider Demographics
NPI:1225112667
Name:GWYNN, MATTHEWS W (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEWS
Middle Name:W
Last Name:GWYNN
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 1:5673 PEACHTREE DUNWOODY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1775
Mailing Address - Country:US
Mailing Address - Phone:404-256-3720
Mailing Address - Fax:404-843-9032
Practice Address - Street 1:5673 PEACHTREE DUNWOODY RD STE 300
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1775
Practice Address - Country:US
Practice Address - Phone:404-256-3720
Practice Address - Fax:404-843-9032
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034147174400000X, 2084N0400X
KY444182084N0400X
AZ466962084N0400X
FLME1175032084N0400X
NC2010-020362084N0400X
VA01010451142084N0400X
SC330502084N0400X
IN01079030A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA13BDCHVMedicare PIN
GAC73421Medicare UPIN