Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 88009 | GA |
NPI | 1013328293 |
---|---|
Provider Name | Dr. Matthew Wayne Oglesby |
First Address | Mcdonough, GA 30253-6649 |
Second Address | Napa, CA 94558-3060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2014 |
Last Update Date | 12/05/2021 |