Individual
MISS KELLY MATTHEWS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP SPEECH THERAPIST
Contact information
Practice address
118 HERRON STREET, FT OGLETHORPE, GA 30742
(706) 861-7471
(706) 861-7472
Mailing address
118 HERRON STREET, FT OGLETHORPE, GA 30742
(706) 861-7471
(706) 861-7472
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP004877
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00929596A
—
GA
01
—
10052439
AMERIGROUP
—
01
—
339855
WELLCARE
—
01
—
4038426
BCBS
TN
01
—
52068699001
BCBS
GA
Enumeration date
12/14/2006
Last updated
07/08/2007
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