Provider Demographics
NPI:1629637343
Name:WALSH, MATTHEW BOYD (MMSC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:BOYD
Last Name:WALSH
Suffix:
Gender:M
Credentials:MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2470 CHESHIRE BRIDGE RD NE APT 2452
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-4008
Mailing Address - Country:US
Mailing Address - Phone:631-834-2056
Mailing Address - Fax:
Practice Address - Street 1:1365 CLIFTON RD NE STE 2200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-727-5979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS