Provider Demographics
NPI:1790021012
Name:MATTHEWS, FARRELL JR (COMS)
Entity Type:Individual
Prefix:MR
First Name:FARRELL
Middle Name:
Last Name:MATTHEWS
Suffix:JR
Gender:M
Credentials:COMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 WASHINGTON RD
Mailing Address - Street 2:B-104
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-7100
Mailing Address - Country:US
Mailing Address - Phone:404-849-1344
Mailing Address - Fax:
Practice Address - Street 1:2807 WASHINGTON RD
Practice Address - Street 2:B-104
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-7100
Practice Address - Country:US
Practice Address - Phone:404-849-1344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16322255R0406X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind