Provider Demographics
NPI:1922035344
Name:KODSI, MATTHEW H (MD PHD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:H
Last Name:KODSI
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 GLENWOOD DR
Mailing Address - Street 2:STE 467-WEST
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404
Mailing Address - Country:US
Mailing Address - Phone:423-698-3423
Mailing Address - Fax:423-698-1380
Practice Address - Street 1:721 GLENWOOD DR
Practice Address - Street 2:STE 467-WEST
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404
Practice Address - Country:US
Practice Address - Phone:423-698-3423
Practice Address - Fax:423-698-1380
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000364172084N0400X
GA0461432084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000951882AMedicaid
3874860Medicare ID - Type Unspecified
GA000951882AMedicaid