Individual
MICHAEL MATHSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
130 W. RAVINE RD., KINGSPORT, TN 37660
(423) 224-3450
(423) 224-3458
Mailing address
119 BOONE RIDGE DRIVE, SUITE 201, JOHNSON CITY, TN 37615
(423) 282-1480
(423) 928-1353
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
1537
TN
363A00000X
Physician Assistant
Primary
1537
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1516958
—
TN
Enumeration date
10/12/2007
Last updated
07/21/2011
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