Provider Demographics
NPI:1285291070
Name:MATHEW, JENSON T (MD)
Entity type:Individual
Prefix:DR
First Name:JENSON
Middle Name:T
Last Name:MATHEW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3085 SCARLET OAK PASS
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-1648
Mailing Address - Country:US
Mailing Address - Phone:912-584-9416
Mailing Address - Fax:
Practice Address - Street 1:367 CLEAR CREEK PKWY
Practice Address - Street 2:
Practice Address - City:LAVONIA
Practice Address - State:GA
Practice Address - Zip Code:30553-4173
Practice Address - Country:US
Practice Address - Phone:912-584-9416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA91384207Q00000X, 208M00000X
GA10952207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist