Provider Demographics
NPI:1285635383
Name:SOCKWELL, MATTHEW DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DEAN
Last Name:SOCKWELL
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:PO BOX 1565
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-0027
Mailing Address - Country:US
Mailing Address - Phone:706-867-4116
Mailing Address - Fax:706-867-4120
Practice Address - Street 1:104 ANSLEY DR
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1614
Practice Address - Country:US
Practice Address - Phone:706-867-4116
Practice Address - Fax:706-867-4120
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036616207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA217890OtherBCBSGA PROVIDER ID NUMBER
GA000539107IMedicaid
GA217890OtherBCBSGA PROVIDER ID NUMBER
GA05BDGKLMedicare ID - Type Unspecified
GAF53402Medicare UPIN