Individual
DR. MATTHEW ANTHONY THREADGILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1245 AUGUSTA WEST PKWY, AUGUSTA, GA 30909-1807
(706) 868-0389
(706) 651-0729
Mailing address
1245 AUGUSTA WEST PKWY, AUGUSTA, GA 30909-1807
(706) 868-0389
(706) 651-0729
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
002452
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002452
RESIDENCY TRAINING PERMIT
GA
01
—
064081
GA LICENSES
GA
05
—
286300162A
—
GA
Enumeration date
06/28/2007
Last updated
07/20/2010
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