Provider Demographics
NPI:1457016859
Name:MALLO, FRANCIS BRENT
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:BRENT
Last Name:MALLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1098
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774-1898
Mailing Address - Country:US
Mailing Address - Phone:865-317-5007
Mailing Address - Fax:
Practice Address - Street 1:109 GREYWOOD PL
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-5655
Practice Address - Country:US
Practice Address - Phone:865-317-5007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health