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NPI Code Detail

MEDICARE: DR. EDWARD KEMP MALLORY DPH

MEDICARE: DR. EDWARD KEMP MALLORY DPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist8967TN

General Provider Information

NPI Number : 1184930570
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDWARD KEMP MALLORY DPH
Provider Business Mailing Address
First Line : 2806 OLD SMITH SPRINGS ROAD
Second Line :
City : NASHVILLE
State : TN
Zip : 37217-4311
Country : US
Telephone Number : 615-361-0182
Fax Number : 615-367-9267
Provider Business Practice Location Address
First Line : 2806 OLD SMITH SPRINGS ROAD
Second Line :
City : NASHVILLE
State : TN
Zip : 37217-4311
Country : US
Telephone Number : 615-361-0182
Fax Number : 615-361-9267
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2010
Last Update Date : 08/24/2010

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