Individual
COLIN O MATHENY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
100 THREE RIVERS DR NE, ROME, GA 30161-4999
(706) 292-0040
(706) 378-0556
Mailing address
100 THREE RIVERS DR NE, ROME, GA 30161-4999
(706) 292-0040
(706) 378-0556
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
004874
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
902115928A
—
GA
05
—
902115928B
—
GA
05
—
902115928C
—
GA
05
—
902115928D
—
GA
Enumeration date
10/02/2006
Last updated
10/15/2010
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