1942415153 NPI number — THOMAS C MATTHEWS MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942415153 NPI number — THOMAS C MATTHEWS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATTHEWS
Provider First Name:
THOMAS
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942415153
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6300 HOSPITAL PKWY STE 375
Provider Second Line Business Mailing Address:
NORTH ATLANTA VASCULAR CLINIC
Provider Business Mailing Address City Name:
JOHNS CREEK
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30097-2461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-771-5260
Provider Business Mailing Address Fax Number:
770-771-5269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6300 HOSPITAL PKWY STE 375
Provider Second Line Business Practice Location Address:
NORTH ATLANTA VASCULAR CLINIC
Provider Business Practice Location Address City Name:
JOHNS CREEK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30097-2461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-771-5260
Provider Business Practice Location Address Fax Number:
770-771-5269
Provider Enumeration Date:
05/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  27103 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 075295 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2086S0129X , with the licence number: 075295 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 128788 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00389731 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003176992A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051116981 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 128787 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 128789 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051116986 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051116984 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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