Active NPI
Kathy Kennedy Matthews, ATC
- Athletic Trainer
- Bremen, GA
National Provider Identifier
1124579263
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT000639
- Practice address
- 504 Georgia Ave S
Bremen, GA 30110-2122 - Phone
- (770) 537-2592
- NPI assigned
- Oct 24, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT000639 | GA | Primary |
Addresses
Primary practice location
504 Georgia Ave S
Bremen, GA 30110-2122
Mailing address
504 Georgia Ave S
Bremen, GA 30110-2122
Phone (770) 537-2592
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT000639 | GA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1477267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1477267200000",
"number": "1124579263",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "504 GEORGIA AVE S",
"city": "BREMEN",
"state": "GA",
"postal_code": "301102122",
"telephone_number": "770-537-2592"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "504 GEORGIA AVE S",
"city": "BREMEN",
"state": "GA",
"postal_code": "301102122",
"telephone_number": "770-537-2592"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTHEWS",
"first_name": "KATHY",
"middle_name": "KENNEDY",
"name_prefix": "Mrs.",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-10-24",
"last_updated": "2016-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "GA",
"license": "AT000639",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bremen, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.