Provider Demographics
NPI:1093286239
Name:MATTHEW W. MCCLANAHAN, DO, PLLC
Entity Type:Organization
Organization Name:MATTHEW W. MCCLANAHAN, DO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR, OWNER, FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLANAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:573-268-2905
Mailing Address - Street 1:6237 VANCE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2954
Mailing Address - Country:US
Mailing Address - Phone:423-352-7489
Mailing Address - Fax:800-878-1232
Practice Address - Street 1:6237 VANCE RD STE 3
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2954
Practice Address - Country:US
Practice Address - Phone:423-352-7489
Practice Address - Fax:800-878-1232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty