Provider Demographics
NPI:1811123300
Name:MATHEWS, JOSEPH WOLFGANG (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WOLFGANG
Last Name:MATHEWS
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:PO BOX 530062
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0062
Mailing Address - Country:US
Mailing Address - Phone:843-695-6071
Mailing Address - Fax:843-569-5879
Practice Address - Street 1:1101 OLD TROLLEY RD
Practice Address - Street 2:STE. 300
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5293
Practice Address - Country:US
Practice Address - Phone:843-376-2670
Practice Address - Fax:843-376-2790
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD31768207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01725510OtherRAILROAD MEDICARE
SC317687Medicaid
SCAA97215281Medicare PIN
SCP01725510OtherRAILROAD MEDICARE