Provider Demographics
NPI:1942415153
Name:MATTHEWS, THOMAS C (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 HOSPITAL PKWY STE 375
Mailing Address - Street 2:NORTH ATLANTA VASCULAR CLINIC
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2461
Mailing Address - Country:US
Mailing Address - Phone:770-771-5260
Mailing Address - Fax:770-771-5269
Practice Address - Street 1:6300 HOSPITAL PKWY STE 375
Practice Address - Street 2:NORTH ATLANTA VASCULAR CLINIC
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-2461
Practice Address - Country:US
Practice Address - Phone:770-771-5260
Practice Address - Fax:770-771-5269
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27103208600000X
GA075295208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL128788Medicaid
MS00389731Medicaid
GA003176992AMedicaid
AL051116981OtherBCBS
AL128787Medicaid
AL128789Medicaid
AL051116986OtherBCBS
AL051116984OtherBCBS
AL102I774679Medicare PIN
AL128788Medicaid