Provider Demographics
NPI:1235482985
Name:MATHEWS, FELECIA (MS RD CDE)
Entity Type:Individual
Prefix:MS
First Name:FELECIA
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:MS RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5823 WILTSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-4747
Mailing Address - Country:US
Mailing Address - Phone:706-718-5421
Mailing Address - Fax:706-322-7334
Practice Address - Street 1:1905 7TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1563
Practice Address - Country:US
Practice Address - Phone:706-507-7067
Practice Address - Fax:706-507-7068
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD000107133VN1006X
GA09520320163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA71BBBDVMedicare UPIN