Healthcare Provider Details

I. General information

NPI: 1356936595
Provider Name (Legal Business Name): HITCHCOCK FAMILY MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5104 HIXSON PIKE
HIXSON TN
37343-3932
US

IV. Provider business mailing address

5104 HIXSON PIKE
HIXSON TN
37343-3932
US

V. Phone/Fax

Practice location:
  • Phone: 423-763-1942
  • Fax:
Mailing address:
  • Phone: 423-763-1942
  • Fax: 423-763-1842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW RAY HITCHCOCK
Title or Position: OWNER
Credential: MD
Phone: 423-763-1942