Provider Demographics
NPI:1841379609
Name:MATHEWS, KENNETH MILTON JR (MD MSPH FACPM)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MILTON
Last Name:MATHEWS
Suffix:JR
Gender:M
Credentials:MD MSPH FACPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 WEST 4TH NORTH ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814
Mailing Address - Country:US
Mailing Address - Phone:423-581-3490
Mailing Address - Fax:423-581-0657
Practice Address - Street 1:812 WEST 4TH NORTH ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814
Practice Address - Country:US
Practice Address - Phone:423-581-3490
Practice Address - Fax:423-581-0657
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD012570TN207P00000X, 207Q00000X, 207R00000X, 2083P0500X, 2083P0901X, 208D00000X
NCMD9700433NC207P00000X, 207Q00000X, 207R00000X, 2083P0500X, 2083P0901X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Not Answered2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
3182141Medicare ID - Type Unspecified
D32143Medicare UPIN