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General NPI Number Information
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NPI Number | 1730330028
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Entity Type | Individual
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Provider Name | MARY ALEXIS DUFFY M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/04/2008
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Last Update Date | 10/04/2008
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Provider Practice Location Address
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Address Line | 255 S CREST RD
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City | CHATTANOOGA
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State | TN
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Zip | 37404-5522
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Country | US
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Telephone | 423-698-4211
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 MCCALLIE AVE
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City | CHATTANOOGA
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State | TN
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Zip | 37403-2814
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Country | US
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Telephone | 423-322-6372
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Fax | 205-268-4404
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number | MEDICAL TN012927
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License Number State | TN
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