Individual
MR. MATTHEW HART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3400 BOB WILSON DRIVE, SAN DIEGO, CA 92134-0001
(912) 547-4013
Mailing address
6829 GA HIGHWAY 17 S, BLOOMINGDALE, GA 31302-4610
(912) 547-4013
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
09/23/2019
Last updated
09/23/2019
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