Individual
MATTHEW T LAVELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
423 MEDICAL PARK DR, SUITE 100, LENOIR CITY, TN 37772-5640
(865) 271-6600
Mailing address
423 MEDICAL PARK DR, SUITE 100, LENOIR CITY, TN 37772-5640
(865) 271-6600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1183
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1510649
—
TN
01
—
P00178344
RR MEDICARE PIN
TN
Enumeration date
06/20/2006
Last updated
04/27/2021
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