Provider Demographics
NPI:1821258641
Name:OCONNELL, MATTHEW (PA C MPAS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:OCONNELL
Suffix:
Gender:M
Credentials:PA C MPAS
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:701 PENN WALLER RD
Mailing Address - Street 2:APT B 3
Mailing Address - City:WILMINGTON ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31410
Mailing Address - Country:US
Mailing Address - Phone:912-257-8274
Mailing Address - Fax:
Practice Address - Street 1:1365 CLIFTON RD NE
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:404-778-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2008-06-17
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical