Provider Demographics
NPI:1992376552
Name:MALLORY, MELINDA (HADS)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:MALLORY
Suffix:
Gender:F
Credentials:HADS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 GREER ST
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-2056
Mailing Address - Country:US
Mailing Address - Phone:229-513-3677
Mailing Address - Fax:
Practice Address - Street 1:1001 GREER ST
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-2056
Practice Address - Country:US
Practice Address - Phone:229-513-3677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS001037237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist