Healthcare Provider Details

I. General information

NPI: 1790149821
Provider Name (Legal Business Name): PAUL WILLIAM MALLORY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7268 JARNIGAN RD STE 200
CHATTANOOGA TN
37421-3097
US

IV. Provider business mailing address

PO BOX 306307
NASHVILLE TN
37230-6307
US

V. Phone/Fax

Practice location:
  • Phone: 423-508-7337
  • Fax:
Mailing address:
  • Phone: 423-424-0383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number61001
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number61001
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: