Healthcare Provider Details

I. General information

NPI: 1801862313
Provider Name (Legal Business Name): MATTHEW SHAWN THOMAS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3114 BROWNS MILL RD
JOHNSON CITY TN
37604-1417
US

IV. Provider business mailing address

836 LAKE POINT DR
PINEY FLATS TN
37686-4524
US

V. Phone/Fax

Practice location:
  • Phone: 423-631-0432
  • Fax:
Mailing address:
  • Phone: 954-336-7665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102201997
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO0000002329
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: