Provider Demographics
NPI:1457699910
Name:ALLISON, MARY DAILEY (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:DAILEY
Last Name:ALLISON
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 CUMBERLAND ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1909
Mailing Address - Country:US
Mailing Address - Phone:423-495-0167
Mailing Address - Fax:423-495-9145
Practice Address - Street 1:425 CUMBERLAND ST
Practice Address - Street 2:SUITE 110
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1909
Practice Address - Country:US
Practice Address - Phone:423-495-0167
Practice Address - Fax:423-495-9145
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2687133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1396091229Medicaid