Provider Demographics
NPI:1427013739
Name:MATTHEWS, T KEITH (DO)
Entity Type:Individual
Prefix:DR
First Name:T
Middle Name:KEITH
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 1:56 APPALACHIAN AVE
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-2271
Mailing Address - Country:US
Mailing Address - Phone:706-781-3994
Mailing Address - Fax:706-781-3997
Practice Address - Street 1:56 APPALACHIAN AVE
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-2271
Practice Address - Country:US
Practice Address - Phone:706-781-3994
Practice Address - Fax:706-781-3997
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA039632OtherLICENSE
GA11D0962278OtherCLIA
GA000717142BMedicaid
NC9601668OtherLICENSE
NC9601668OtherLICENSE
GA000717142BMedicaid
GA039632OtherLICENSE