Healthcare Provider Details

I. General information

NPI: 1740577436
Provider Name (Legal Business Name): ANDREW CURRIER MALLETTE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MARSHALL ST STE 500
JACKSON MS
39202-1615
US

IV. Provider business mailing address

501 MARSHALL ST STE 500
JACKSON MS
39202-1615
US

V. Phone/Fax

Practice location:
  • Phone: 601-948-1411
  • Fax: 601-948-0090
Mailing address:
  • Phone: 601-948-1411
  • Fax: 601-948-0090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberT-2458
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: