Healthcare Provider Details
I. General information
NPI: 1912708678
Provider Name (Legal Business Name): MATRIX MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
975 E 3RD ST
CHATTANOOGA TN
37403-2173
US
IV. Provider business mailing address
124 HARRISON LN STE 120
SODDY DAISY TN
37379-4863
US
V. Phone/Fax
- Phone: 423-414-2770
- Fax:
- Phone: 423-414-2770
- Fax: 989-249-0227
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208VP0000X |
| Taxonomy | Pain Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
RYAN
BEARER
Title or Position: OWNER/PHYSICIAN
Credential: DO
Phone: 423-414-2770