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NPI Code Detail

MEDICARE: MRS. AMITY JILL MALLOY MSN, APN, NP

MEDICARE: MRS. AMITY JILL MALLOY MSN, APN, NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12083A0300XAddiction Medicine (Preventive Medicine) Physician14962TN
2363LP0808XPsychiatric/Mental Health Nurse Practitioner14962TN

General Provider Information

NPI Number : 1720307978
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMITY JILL MALLOY MSN, APN, NP
Provider Business Mailing Address
First Line : 6141 SHALLOWFORD RD STE 100
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-1663
Country : US
Telephone Number : 423-498-2000
Fax Number : 423-498-2001
Provider Business Practice Location Address
First Line : 6141 SHALLOWFORD RD STE 100
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-1663
Country : US
Telephone Number : 423-498-2000
Fax Number : 423-498-2001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2010
Last Update Date : 02/23/2026

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