Provider Demographics
NPI:1295046928
Name:MCCLANAHAN, MATTHEW W (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:W
Last Name:MCCLANAHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:320 EAST MAIN STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37408
Mailing Address - Country:US
Mailing Address - Phone:423-643-2246
Mailing Address - Fax:423-643-2030
Practice Address - Street 1:320 EAST MAIN STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37408
Practice Address - Country:US
Practice Address - Phone:423-643-2246
Practice Address - Fax:423-643-2030
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2015-04-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101018783204D00000X, 207Q00000X
TN2715207Q00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM