Provider Demographics
NPI:1578310116
Name:STAPLES, MATTHEW JARED (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JARED
Last Name:STAPLES
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 1:1608 MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-9905
Mailing Address - Country:US
Mailing Address - Phone:912-537-9488
Mailing Address - Fax:
Practice Address - Street 1:1608 MEADOWS LN
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-9905
Practice Address - Country:US
Practice Address - Phone:912-537-9488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program