Healthcare Provider Details

I. General information

NPI: 1275361545
Provider Name (Legal Business Name): HITCHCOCK FAMILY MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2024
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: 423-456-9134
  • Fax: 423-769-0020
Mailing address:
  • Phone: 423-456-9134
  • Fax: 423-769-0020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MATTHEW HITCHCOCK
Title or Position: OWNER
Credential: MD
Phone: 423-456-9134