Provider Demographics
NPI:1982660148
Name:MATTOCKS, KAREN FISHER (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:FISHER
Last Name:MATTOCKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:KAREN
Other - Middle Name:DENEEN
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:3010 FARROW RD
Practice Address - Street 2:SUITE 300
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-7607
Practice Address - Country:US
Practice Address - Phone:803-434-1210
Practice Address - Fax:803-434-1212
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20030207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC200302Medicaid
SCAA38475770Medicare PIN
SC200302Medicaid
SCAA3847Medicare UPIN