Threadgill, Matthew Anthony

Threadgill, Matthew Anthony is an individual health care provider with primary practice located at 1245 Augusta West Pkwy , Augusta GA 30909-1807. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Threadgill, Matthew Anthony can be contacted via phone (706) 868-0389.

Contact Information

Primary practice address
1245 Augusta West Pkwy Augusta GA 30909-1807
Phone: (706) 868-0389
Fax: (706) 651-0729
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 002452 Georgia

Profile Details

NPI number 1376740977
LBN Legal business name Threadgill, Matthew Anthony
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 28th, 2007
Last updated Jul 20th, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1376740977 NPPES
Georgia MEDICAID 286300162A
Georgia Other 064081
Georgia Other 002452

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