Basic Information
| Provider Information | |||||||||
| NPI: | 1114487220 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AUSTIN | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | KYLE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1120 WELLSTAR WAY STE 105 | ||||||||
| Address2: | |||||||||
| City: | HOLLY SPRINGS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301148952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6784942500 | ||||||||
| FaxNumber: | 6784942629 | ||||||||
| Practice Location | |||||||||
| Address1: | 1120 WELLSTAR WAY STE 105 | ||||||||
| Address2: | |||||||||
| City: | HOLLY SPRINGS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301148952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6784942500 | ||||||||
| FaxNumber: | 6784942629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2019 | ||||||||
| LastUpdateDate: | 08/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | TRN29626 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 92797 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.