Healthcare Provider Details

I. General information

NPI: 1194311670
Provider Name (Legal Business Name): MATTHEW SETH CALLAN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E 3RD ST
CHATTANOOGA TN
37403-2102
US

IV. Provider business mailing address

1905 IGOU CROSSING DR
CHATTANOOGA TN
37421-7139
US

V. Phone/Fax

Practice location:
  • Phone: 423-209-6020
  • Fax:
Mailing address:
  • Phone: 706-936-9493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number240371
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: