Provider Demographics
NPI:1598368581
Name:MCKINNEY, MATTHEW DEAN (EDD, LAT, ATC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DEAN
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:EDD, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535-5252
Mailing Address - Country:US
Mailing Address - Phone:419-618-6018
Mailing Address - Fax:
Practice Address - Street 1:1021 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-5252
Practice Address - Country:US
Practice Address - Phone:706-778-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0014312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer