Provider Demographics
NPI:1932780673
Name:DAVIDSON, MATTHEW GABE (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:GABE
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2839 HIGHWAY 231 N STE 105
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-7448
Mailing Address - Country:US
Mailing Address - Phone:931-488-4014
Mailing Address - Fax:
Practice Address - Street 1:2839 HIGHWAY 231 N STE 105
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-7448
Practice Address - Country:US
Practice Address - Phone:931-488-4014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5807207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine