1700067667 NPI number — MATTHEW JOSHUA WRIGHT MD

Table of content: MATTHEW JOSHUA WRIGHT MD (NPI 1700067667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700067667 NPI number — MATTHEW JOSHUA WRIGHT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WRIGHT
Provider First Name:
MATTHEW
Provider Middle Name:
JOSHUA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700067667
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3549
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37404-0549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-698-3309
Provider Business Mailing Address Fax Number:
423-624-6355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2341 MCCALLIE AVE
Provider Second Line Business Practice Location Address:
SUITE 402
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37404-3239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-698-3309
Provider Business Practice Location Address Fax Number:
423-624-6355
Provider Enumeration Date:
11/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  MD41563 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110631 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 582292601D MMSC , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5911873 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 582292601E PH , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4225390 . This is a "BLUE CROSS BLUE SHIELD OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 582292601B MH , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1513159 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 582292601C PEH , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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