Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 45249 | TN |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | MD-12998 | HI |
N | 208D00000X | General Practice Physician | 12998 | HI |
N | 208D00000X | General Practice Physician | 45249 | TN |
NPI | 1508191248 |
---|---|
Provider Name | Matthew Martin Hine |
First Address | Franklin, TN 37067-1509 |
Second Address | Chattanooga, TN 37408-2250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2009 |
Last Update Date | 09/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000286070 | HMSA BILLING NUMBER (01) | HI |
637340-02 | (05) | HI |
F74360 | (02) | HI |