Basic Information
| Provider Information | |||||||||
| NPI: | 1003142647 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATTHEWS | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 751 CEDAR CREEK RD NW | ||||||||
| Address2: | |||||||||
| City: | CARTERSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301214409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706554426 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 751 CEDAR CREEK RD NW | ||||||||
| Address2: | |||||||||
| City: | CARTERSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301214409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706554426 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2009 | ||||||||
| LastUpdateDate: | 11/01/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 376K00000X | CN0028865250 | GA | Y | Nursing Service Related Providers | Nurse's Aide |
No ID Information.