Basic Information
| Provider Information | |||||||||
| NPI: | 1013328293 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OGLESBY | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | WAYNE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 REGENCY PARK DR | ||||||||
| Address2: | |||||||||
| City: | MCDONOUGH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302536649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048433323 | ||||||||
| FaxNumber: | 4045745944 | ||||||||
| Practice Location | |||||||||
| Address1: | 3421 VILLA LN STE 2B | ||||||||
| Address2: | |||||||||
| City: | NAPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945583060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072555454 | ||||||||
| FaxNumber: | 7072555411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2014 | ||||||||
| LastUpdateDate: | 05/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 88009 | GA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.