Healthcare Provider Details

I. General information

NPI: 1043123755
Provider Name (Legal Business Name): MATRIARCH LONGEVITY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2544 NASHVILLE HWY
COLUMBIA TN
38401-7237
US

IV. Provider business mailing address

2544 NASHVILLE HWY
COLUMBIA TN
38401-7237
US

V. Phone/Fax

Practice location:
  • Phone: 615-506-1509
  • Fax:
Mailing address:
  • Phone: 615-506-1509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: THOMAS CABELL
Title or Position: OWNER
Credential: MD
Phone: 615-506-1509