Provider Demographics
NPI:1497740229
Name:JOHN, MATHEW M (DPM)
Entity Type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:M
Last Name:JOHN
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:2790 SANDY PLAINS RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4378
Mailing Address - Country:US
Mailing Address - Phone:770-977-3668
Mailing Address - Fax:770-578-0033
Practice Address - Street 1:2790 SANDY PLAINS RD
Practice Address - Street 2:SUITE 300
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-4378
Practice Address - Country:US
Practice Address - Phone:770-977-3668
Practice Address - Fax:770-578-0033
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2024-04-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA000926213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA288814528AMedicaid
GAU87730Medicare UPIN
GA1296150001Medicare NSC
GA48SCCHDMedicare ID - Type Unspecified