=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386177137
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW MICHAEL HOLLIE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2017
-----------------------------------------------------
Last Update Date | 07/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 979 E 3RD ST STE A550
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37403-2136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-778-8224
-----------------------------------------------------
Fax | 423-778-9482
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 979 E 3RD ST STE A550
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37403-2136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-778-8224
-----------------------------------------------------
Fax | 423-778-9482
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | 65656
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------