Provider Demographics
NPI:1962854612
Name:WARNER, MATTHEW CLINTON (ATC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CLINTON
Last Name:WARNER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 JARRATT DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVALE
Mailing Address - State:TN
Mailing Address - Zip Code:37153-4042
Mailing Address - Country:US
Mailing Address - Phone:615-278-0547
Mailing Address - Fax:
Practice Address - Street 1:1523 JARRATT DR
Practice Address - Street 2:
Practice Address - City:ROCKVALE
Practice Address - State:TN
Practice Address - Zip Code:37153-4042
Practice Address - Country:US
Practice Address - Phone:615-278-0547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer