MEDICARE: DR. MALLORY ANNE MITCHELL M.D.

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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	2084P0804X	Child & Adolescent Psychiatry Physician	65573	TN

General Provider Information

NPI Number	:	1720514003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MALLORY ANNE MITCHELL M.D.

Provider Business Mailing Address
First Line	:	6030 RIVER OAKS RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38120-2547
Country	:	US
Telephone Number	:	901-338-5426
Fax Number	:

Provider Business Practice Location Address
First Line	:	6030 RIVER OAKS RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38120-2547
Country	:	US
Telephone Number	:	901-338-5426
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2017
Last Update Date	:	06/28/2022

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