Individual
DR. MATTHEW JARED CORNISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-6300
(706) 721-8623
Mailing address
1120 15TH ST # OR6000, AUGUSTA, GA 30912-0004
(706) 721-3813
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
5424381-1205
UT
208000000X
Pediatrics Physician
Primary
94843
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D5468
—
UT
Enumeration date
08/01/2006
Last updated
04/14/2023
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