Provider Demographics
NPI:1679815229
Name:MANDRELL, TIMOTHY DAVID (DVM)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DAVID
Last Name:MANDRELL
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4862 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-5152
Mailing Address - Country:US
Mailing Address - Phone:901-496-7101
Mailing Address - Fax:901-207-6438
Practice Address - Street 1:4862 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-5152
Practice Address - Country:US
Practice Address - Phone:901-496-7101
Practice Address - Fax:901-207-6438
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDV0000002426174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian