Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2715 | TN |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101018783 | MI |
Y | 207Q00000X | Family Doctor | 2715 | TN |
N | 207Q00000X | Family Doctor | 5101018783 | MI |
NPI | 1295046928 |
---|---|
Provider Name | Matthew W Mcclanahan |
First Address | Chattanooga, TN 37408 |
Second Address | Chattanooga, TN 37408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2010 |
Last Update Date | 24/04/2015 |