Provider Demographics
NPI:1235151390
Name:M.D. MATTHEWS CORPORATION
Entity Type:Organization
Organization Name:M.D. MATTHEWS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:WHITEST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-691-5757
Mailing Address - Street 1:PO BOX 92446
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30314-0446
Mailing Address - Country:US
Mailing Address - Phone:404-559-3435
Mailing Address - Fax:404-559-1990
Practice Address - Street 1:2027 METROPOLITAN PKWY SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-5926
Practice Address - Country:US
Practice Address - Phone:404-559-3435
Practice Address - Fax:404-559-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health