Provider Demographics
NPI:1942561121
Name:T. KEITH MATTHEWS, D.O.,P.C.
Entity Type:Organization
Organization Name:T. KEITH MATTHEWS, D.O.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:T
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:706-781-3994
Mailing Address - Street 1:56 APPALACHIAN AVE
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-2271
Mailing Address - Country:US
Mailing Address - Phone:706-781-3994
Mailing Address - Fax:706-781-3997
Practice Address - Street 1:56 APPALACHIAN AVE
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-2271
Practice Address - Country:US
Practice Address - Phone:706-781-3994
Practice Address - Fax:706-781-3997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00717142BMedicaid
GAG42716Medicare UPIN