Provider Demographics
NPI:1568725208
Name:MATTHEWS, GEKECIAL
Entity Type:Individual
Prefix:
First Name:GEKECIAL
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIAPER
Other - Middle Name:
Other - Last Name:DISCRETION
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6158 GRAY OAK AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-2710
Mailing Address - Country:US
Mailing Address - Phone:901-859-5083
Mailing Address - Fax:
Practice Address - Street 1:6158 GRAY OAK AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-2710
Practice Address - Country:US
Practice Address - Phone:901-859-5083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN332BN1400X332BN1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies