Provider Demographics
NPI:1235751934
Name:HINKLE, MATTHEW DELANEY (RN)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DELANEY
Last Name:HINKLE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 STONEGATE LN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-6683
Mailing Address - Country:US
Mailing Address - Phone:678-386-6393
Mailing Address - Fax:
Practice Address - Street 1:148 STONEGATE LN
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-6683
Practice Address - Country:US
Practice Address - Phone:678-386-6393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN268161163WC0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine