Basic Information
| Provider Information | |||||||||
| NPI: | 1295046928 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCLANAHAN | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 320 EAST MAIN STREET | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236432246 | ||||||||
| FaxNumber: | 4236432030 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 EAST MAIN STREET | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236432246 | ||||||||
| FaxNumber: | 4236432030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2010 | ||||||||
| LastUpdateDate: | 04/24/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204D00000X | 5101018783 | MI | N | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM | 207Q00000X | 5101018783 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2715 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine | 204D00000X | 2715 | TN | N | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM |
No ID Information.