Individual
MATTHEW JOHN KHAYATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9 RICHLAND MEDICAL PARK DR STE 110, COLUMBIA, SC 29203-6859
(803) 434-7961
(803) 758-0134
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
88250
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2017
Last updated
07/15/2022
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