Basic Information
| Provider Information | |||||||||
| NPI: | 1942524434 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANSERD | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 GREAT CIRCLE RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372281317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152226977 | ||||||||
| FaxNumber: | 6152225322 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 W MARKET ST | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356112457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562626738 | ||||||||
| FaxNumber: | 2562626731 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2010 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 207R00000X | 49759 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 33722 | AL | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 49759 | TN | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 33722 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1531854 | 05 | TN | MEDICAID | 6011134 | 01 | TN | BCBS | OTHER | 7100242280 | 05 | KY | MEDICAID |