Healthcare Provider Details

I. General information

NPI: 1336330596
Provider Name (Legal Business Name): MATTHEW JOHN CAFFREY MD/MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N BROADWAY ST
JOHNSON CITY TN
37601-3525
US

IV. Provider business mailing address

102 N BROADWAY ST
JOHNSON CITY TN
37601-3525
US

V. Phone/Fax

Practice location:
  • Phone: 423-588-9978
  • Fax:
Mailing address:
  • Phone: 423-588-9978
  • Fax: 423-722-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD53546
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD53546
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: