Provider Demographics
NPI:1598163644
Name:MALONE, DENISE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 E JAMES CAMPBELL SUITE 113
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401
Mailing Address - Country:US
Mailing Address - Phone:931-490-1580
Mailing Address - Fax:931-490-1506
Practice Address - Street 1:230 E JAMES CAMPBELL BLVD STE 113
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-0504
Practice Address - Country:US
Practice Address - Phone:931-490-1580
Practice Address - Fax:931-490-1506
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator