Provider Demographics
NPI:1669475018
Name:FLINT, MARY JO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY JO
Middle Name:
Last Name:FLINT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY JO
Other - Middle Name:
Other - Last Name:KOPPENHAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:79 HIGHWAY 51 S
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:TN
Mailing Address - Zip Code:38063-4580
Mailing Address - Country:US
Mailing Address - Phone:731-635-8189
Mailing Address - Fax:
Practice Address - Street 1:656 KIMBERLY DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-2007
Practice Address - Country:US
Practice Address - Phone:731-989-5180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0425097174400000X
TN63648208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist