Provider Demographics
NPI:1245398478
Name:MATTHEWSON, JANICE C (MD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:C
Last Name:MATTHEWSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:CONCHITTA
Other - Last Name:BURNETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3495 PIEDMONT ROAD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-9775
Mailing Address - Country:US
Mailing Address - Phone:404-364-7000
Mailing Address - Fax:404-364-4732
Practice Address - Street 1:2400 MOUNT ZION PARKWAY
Practice Address - Street 2:FAMILY PRACTICE HEALTH CARE TEAM A
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236
Practice Address - Country:US
Practice Address - Phone:770-603-3649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014288207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B61745Medicare UPIN
08BDGXPMedicare ID - Type Unspecified