Provider Demographics
NPI:1790404119
Name:MATTHEWS, JAQUAVIA B
Entity Type:Individual
Prefix:
First Name:JAQUAVIA
Middle Name:B
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-4261
Mailing Address - Country:US
Mailing Address - Phone:910-384-4631
Mailing Address - Fax:
Practice Address - Street 1:713 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-4261
Practice Address - Country:US
Practice Address - Phone:910-384-4631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)