Provider Demographics
NPI:1992388524
Name:MAT CENTERS OF TENNESSEE LLC
Entity Type:Organization
Organization Name:MAT CENTERS OF TENNESSEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:MARCIA
Authorized Official - Last Name:ROTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:615-715-8769
Mailing Address - Street 1:9206 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7407
Mailing Address - Country:US
Mailing Address - Phone:931-801-2558
Mailing Address - Fax:
Practice Address - Street 1:1950 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2204
Practice Address - Country:US
Practice Address - Phone:931-557-3025
Practice Address - Fax:931-557-3025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-02
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty