Provider Demographics
NPI:1255754461
Name:ADAMS, MATTHEW JONATHAN (FNP-BC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JONATHAN
Last Name:ADAMS
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2976 HIGHWAY 76 STE B&C
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30705-6981
Mailing Address - Country:US
Mailing Address - Phone:706-517-0656
Mailing Address - Fax:706-517-0651
Practice Address - Street 1:2976 HIGHWAY 76 STE B&C
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-6981
Practice Address - Country:US
Practice Address - Phone:706-517-0656
Practice Address - Fax:706-517-0651
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN176258363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily