Provider Demographics
NPI:1548323967
Name:MATTHEWS, JODY ALLEN (DC BA)
Entity type:Individual
Prefix:DR
First Name:JODY
Middle Name:ALLEN
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:DC BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PROSPECTER DR
Mailing Address - Street 2:P.O. BOX 579
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-1098
Mailing Address - Country:US
Mailing Address - Phone:770-459-5070
Mailing Address - Fax:770-459-1070
Practice Address - Street 1:120 PROSPECTER DR
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1098
Practice Address - Country:US
Practice Address - Phone:770-459-5070
Practice Address - Fax:770-459-1070
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCFKHMedicare ID - Type UnspecifiedMEDICARE #