Healthcare Provider Details

I. General information

NPI: 1225667249
Provider Name (Legal Business Name): MALLORY BROWNING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 09/10/2022
Certification Date: 09/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NORTH STATE STREET
JACKSON MS
39216-4505
US

IV. Provider business mailing address

6018 ROSEMEAD CIR
BOSSIER CITY LA
71111-5675
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5582
  • Fax:
Mailing address:
  • Phone: 318-455-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberT-4085
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: