Provider Demographics
NPI:1306607148
Name:MATUZAK, MADISON J (PA-C)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:J
Last Name:MATUZAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 LAKEPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31407-3551
Mailing Address - Country:US
Mailing Address - Phone:515-720-6687
Mailing Address - Fax:
Practice Address - Street 1:168 LAKEPOINTE DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31407-3551
Practice Address - Country:US
Practice Address - Phone:515-720-6687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4885363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant