Basic Information
| Provider Information | |||||||||
| NPI: | 1306845458 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATHEWS | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 818 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9128266000 | ||||||||
| FaxNumber: | 9128266016 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 GOSHEN RD | ||||||||
| Address2: | |||||||||
| City: | RINCON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313265545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9128266000 | ||||||||
| FaxNumber: | 9128266016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2005 | ||||||||
| LastUpdateDate: | 09/23/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 049133 | GA | N | Other Service Providers | Specialist | 207Q00000X | 049133 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 826744435A | 05 | GA | MEDICAID |