Provider Demographics
NPI:1225031537
Name:TINNEY, MATTHEW C (DO)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:C
Last Name:TINNEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4841 HIXSON PIKE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4431
Mailing Address - Country:US
Mailing Address - Phone:423-305-7980
Mailing Address - Fax:423-305-7981
Practice Address - Street 1:4841 HIXSON PIKE
Practice Address - Street 2:SUITE A
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4431
Practice Address - Country:US
Practice Address - Phone:423-305-7980
Practice Address - Fax:423-305-7981
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1241207P00000X, 207Q00000X
FLOS10663207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE65257Medicare UPIN
103I088303Medicare PIN