# MIND AND BODY WELLNESS CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063048668
- **Authorized official:** TONYA M MALADY (CREDENTIALING)
- **Authorized official phone:** (901) 737-1992

## Contact information

- **Practice address:** 1176 VICKERY LN STE 100, CORDOVA, TN 38016-0631
- **Practice address phone:** (901) 737-1992
- **Mailing address:** 1176 VICKERY LN STE 100, CORDOVA, TN 38016-0631
- **Mailing address phone:** (901) 737-1992
- **Mailing address fax:** (901) 309-8784

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | Yes |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/16/2020
- **Last updated:** 03/16/2020