Healthcare Provider Details

I. General information

NPI: 1750460515
Provider Name (Legal Business Name): KENNETH MATHEWS JR MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 WEST 4TH NORTH ST
MORRISTOWN TN
37814
US

IV. Provider business mailing address

812 WEST 4TH NORTH ST
MORRISTOWN TN
37814
US

V. Phone/Fax

Practice location:
  • Phone: 423-581-3490
  • Fax: 423-581-0657
Mailing address:
  • Phone: 423-581-3490
  • Fax: 423-581-0657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD012570TN
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD9700433NC
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD012570TN
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD9700433NC
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD012570TN
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9700433NC
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberMD012570TN
License Number StateTN
# 8
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberMD9700433NC
License Number StateNC
# 9
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberMD012570TN
License Number StateTN
# 10
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD012570TN
License Number StateTN
# 11
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number9700433NC
License Number StateNC
# 12
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number9700433NC
License Number StateNC

VIII. Authorized Official

Name: DR. KENNETH MILTON MATHEWS JR.
Title or Position: PRESIDENT OWNER
Credential: MD MSPH FACPM
Phone: 423-581-3490