Provider Demographics
NPI:1235215518
Name:KING, MATTHEW S (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:S
Last Name:KING
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 1:1156 NASHVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-3110
Mailing Address - Country:US
Mailing Address - Phone:615-989-1088
Mailing Address - Fax:
Practice Address - Street 1:555 HARTSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-2400
Practice Address - Country:US
Practice Address - Phone:615-328-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40559207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4158897OtherBCBS
KY7100033580OtherKENTUCKY MEDICAID
9340126OtherAETNA
TN3001035Medicaid
P00630872OtherRAILROAD MEDICARE
30001035Medicare PIN