NPI Code Detail JSON Logo

1942880646 NPI number — MALLIE MARIE DENNIS MD

NPI Number: 1942880646
Health Care Provider/Practitioner: MALLIE MARIE DENNIS MD

Information about “1942880646” NPI (MALLIE MARIE DENNIS MD) exists in 1942880646 in HTML format HTML  |  1942880646 in plain Text format TXT  |  1942880646 in PDF (Portable Document Format) PDF  |  1942880646 in an XML format XML  formats.

NPI Number : 1942880646 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1942880646",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DENNIS",
    "FirstName": "MALLIE",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "350 N HUMPHREYS BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MEMPHIS",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "38120-2177",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "901-226-4003",
    "MailingAddressFaxNumber": "901-227-8591",
    "FirstLinePracticeLocationAddress": "100 HOSPITAL ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BOONEVILLE",
    "PracticeLocationAddressStateName": "MS",
    "PracticeLocationAddressPostalCode": "38829-3354",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "662-720-5000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/08/2021",
    "LastUpdateDate": "09/30/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2084P0800X",
        "TaxonomyName": "Psychiatry Physician",
        "LicenseNumber": "34904",
        "LicenseNumberStateCode": "MS",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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