Provider Demographics
NPI:1902368251
Name:MATHEWS, CANDLER GRADY III
Entity type:Individual
Prefix:MR
First Name:CANDLER
Middle Name:GRADY
Last Name:MATHEWS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 PARIS AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-5931
Mailing Address - Country:US
Mailing Address - Phone:803-840-3619
Mailing Address - Fax:
Practice Address - Street 1:1215 21ST AVE S STE AND4200
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-7101
Practice Address - Country:US
Practice Address - Phone:615-936-7846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program