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General NPI Number Information
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NPI Number | 1255682381
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Entity Type | Individual
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Provider Name | EDNA ELAINE MALLORY NP-C
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Gender | Female
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Dates
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Enumeration Date | 09/28/2012
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 2169 W POINT RD
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City | LAGRANGE
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State | GA
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Zip | 30240-4002
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Country | US
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Telephone | 706-902-9516
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Fax |
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Provider Business Mailing Address
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Address Line | 35 ELY CALLAWAY ROAD
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City | WEST POINT
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State | GA
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Zip | 31833
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Country | US
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Telephone | 706-885-1401
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN185828
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-108083
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License Number State | AL
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