Provider Demographics
NPI:1780023713
Name:ADAMS, MATTYE L
Entity type:Individual
Prefix:
First Name:MATTYE
Middle Name:L
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 20TH AVE N STE 403
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5180
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:615-284-7501
Practice Address - Street 1:2011 MURPHY AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2023
Practice Address - Country:US
Practice Address - Phone:615-327-9543
Practice Address - Fax:615-341-3568
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2374363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I977615Medicare PIN