Provider Demographics
NPI:1558434605
Name:MATHEWS, WAYNE S (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:S
Last Name:MATHEWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 28068
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37424-8068
Mailing Address - Country:US
Mailing Address - Phone:877-899-1033
Mailing Address - Fax:423-892-5838
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:ROOM 2144
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-3873
Practice Address - Fax:706-721-7763
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2008-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA022834207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA550789920OtherTRICARE
GA000263964BMedicaid
GA050091609OtherRRMEDICARE
GA000263964CMedicaid
GA048400OtherBCBS
GA339265OtherWELLCARE CMO
SCG22834Medicaid
GA000263964CMedicaid
GAD46040Medicare UPIN