Healthcare Provider Details

I. General information

NPI: 1992388524
Provider Name (Legal Business Name): MAT CENTERS OF TENNESSEE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2021
Last Update Date: 05/02/2021
Certification Date: 05/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 N JACKSON ST
TULLAHOMA TN
37388-2204
US

IV. Provider business mailing address

9206 CONCORD RD
BRENTWOOD TN
37027-7407
US

V. Phone/Fax

Practice location:
  • Phone: 931-557-3025
  • Fax: 931-557-3025
Mailing address:
  • Phone: 931-801-2558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: RUTH MARCIA ROTHMAN
Title or Position: COO
Credential: RPH
Phone: 615-715-8769