Provider Demographics
NPI:1346344355
Name:MATTHEWS, EDWARD A (DO)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:A
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:DO
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 9006
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-9006
Mailing Address - Country:US
Mailing Address - Phone:706-323-5552
Mailing Address - Fax:706-323-3066
Practice Address - Street 1:2300 MANCHESTER EXPY
Practice Address - Street 2:STE 2001
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6802
Practice Address - Country:US
Practice Address - Phone:706-323-5552
Practice Address - Fax:706-323-3066
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA34896174400000X
ALDO376174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000471633Medicaid
AL167594Medicaid
AL167594Medicaid
ALDO376OtherAL STATE LICENSE
GA06BDBWRMedicare ID - Type Unspecified