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General NPI Number Information
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NPI Number | 1649536350
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Entity Type | Individual
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Provider Name | MARY ELAINE KILLIAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/06/2012
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 51 N DUNLAP ST
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City | MEMPHIS
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State | TN
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Zip | 38105-4625
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Country | US
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Telephone | 901-287-7337
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Fax | 901-937-6691
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Provider Business Mailing Address
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Address Line | 850 POPLAR AVE BLDG 2
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City | MEMPHIS
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State | TN
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Zip | 38105-4607
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Country | US
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Telephone |
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 59126
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number | 59126
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License Number State | TN
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