Healthcare Provider Details

I. General information

NPI: 1518209089
Provider Name (Legal Business Name): MALLORY BAKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MALLORY CAMILLE FAULKNER

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 PRESIDENT PL STE 200
SMYRNA TN
37167-6809
US

IV. Provider business mailing address

741 PRESIDENT PL STE 200
SMYRNA TN
37167-6809
US

V. Phone/Fax

Practice location:
  • Phone: 615-459-7104
  • Fax: 615-459-7822
Mailing address:
  • Phone: 615-459-7104
  • Fax: 615-459-7822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number55808
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number55808
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: