Provider Demographics
NPI:1720553027
Name:HEARD, MATTHEW TRACE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:TRACE
Last Name:HEARD
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:25073 HIGHWAY 85
Mailing Address - Street 2:
Mailing Address - City:GAY
Mailing Address - State:GA
Mailing Address - Zip Code:30218-1237
Mailing Address - Country:US
Mailing Address - Phone:770-639-2416
Mailing Address - Fax:478-352-0095
Practice Address - Street 1:2011 COMMERCE DR N STE 25
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3538
Practice Address - Country:US
Practice Address - Phone:844-994-6633
Practice Address - Fax:478-352-0095
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2023-02-07
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Provider Licenses
StateLicense IDTaxonomies
GA009061363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant