Healthcare Provider Details

I. General information

NPI: 1063491280
Provider Name (Legal Business Name): MATTHEW W MABIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 POPLAR AVE SUITE 800
MEMPHIS TN
38157-0101
US

IV. Provider business mailing address

5050 POPLAR AVE SUITE 800
MEMPHIS TN
38157-0101
US

V. Phone/Fax

Practice location:
  • Phone: 901-333-8443
  • Fax: 901-333-8443
Mailing address:
  • Phone: 901-276-2662
  • Fax: 901-274-2033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number32256
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number32256
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: