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General NPI Number Information
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NPI Number | 1801449756
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Entity Type | Individual
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Provider Name | MALLORY MORRIS COLLINS OD
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Gender | Female
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Dates
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Enumeration Date | 07/19/2019
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 325 LEE DR
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City | CLARKSDALE
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State | MS
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Zip | 38614-1912
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Country | US
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Telephone | 662-627-2887
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Fax | 662-495-4082
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Provider Business Mailing Address
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Address Line | 325 W LEE DR
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City | CLARKSDALE
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State | MS
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Zip | 38614-1912
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Country | US
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Telephone | 662-627-2887
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Fax | 662-495-4082
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 990
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License Number State | MS
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