Provider Demographics
NPI:1316370851
Name:VARN, MATTHEW NIJEM (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:NIJEM
Last Name:VARN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3301 N OAK STREET EXT
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-1014
Mailing Address - Country:US
Mailing Address - Phone:229-242-6061
Mailing Address - Fax:229-242-6151
Practice Address - Street 1:3301 N OAK STREET EXT
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-1014
Practice Address - Country:US
Practice Address - Phone:229-242-6061
Practice Address - Fax:229-242-6151
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009121207R00000X
GA390200000X
GA84968207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program