Provider Demographics
NPI:1831989961
Name:MATHIS, TOWONNDA
Entity type:Individual
Prefix:
First Name:TOWONNDA
Middle Name:
Last Name:MATHIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 17TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44703-1043
Mailing Address - Country:US
Mailing Address - Phone:234-499-0979
Mailing Address - Fax:234-499-0979
Practice Address - Street 1:1419 17TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44703-1043
Practice Address - Country:US
Practice Address - Phone:234-499-0979
Practice Address - Fax:234-499-0979
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor