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General NPI Number Information
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NPI Number | 1992388524
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Entity Type | Organization
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Legal Business Name | MAT CENTERS OF TENNESSEE LLC
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Dates
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Enumeration Date | 05/02/2021
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Last Update Date | 05/02/2021
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Provider Practice Location Address
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Address Line | 1950 N JACKSON ST
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City | TULLAHOMA
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State | TN
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Zip | 37388-2204
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Country | US
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Telephone | 931-557-3025
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Fax | 931-557-3025
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Provider Business Mailing Address
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Address Line | 9206 CONCORD RD
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City | BRENTWOOD
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State | TN
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Zip | 37027-7407
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Country | US
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Telephone | 931-801-2558
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Fax |
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Authorized Official
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Title or Position | COO
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Name | RUTH MARCIA ROTHMAN
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Credential | RPH
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Telephone | 615-715-8769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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