Provider Demographics
NPI:1487819173
Name:MATTHEWS, ALIYA (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALIYA
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:ALIYA
Other - Middle Name:
Other - Last Name:FAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1204 BENTLEY ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7786
Mailing Address - Country:US
Mailing Address - Phone:609-922-1866
Mailing Address - Fax:
Practice Address - Street 1:1204 BENTLEY ESTATES DR
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-7786
Practice Address - Country:US
Practice Address - Phone:609-922-1866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001184213E00000X
PASC006065213ES0103X, 390200000X
MD01490213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program