Provider Demographics
NPI:1154173839
Name:MATCHEN, DEMETRIUS
Entity type:Individual
Prefix:MR
First Name:DEMETRIUS
Middle Name:
Last Name:MATCHEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 STONEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-4615
Mailing Address - Country:US
Mailing Address - Phone:615-779-1822
Mailing Address - Fax:
Practice Address - Street 1:3605 STONEWOOD CT
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-4615
Practice Address - Country:US
Practice Address - Phone:615-779-1822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1000000034299261QM0850X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health