Organization
MIND AND BODY WELLNESS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONYA M MALADY (CREDENTIALING)
(901) 737-1992
Entity
Organization
Contact information
Practice address
1176 VICKERY LN STE 100, CORDOVA, TN 38016-0631
(901) 737-1992
Mailing address
1176 VICKERY LN STE 100, CORDOVA, TN 38016-0631
(901) 737-1992
(901) 309-8784
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44725
LICENSE
TN
Enumeration date
03/16/2020
Last updated
03/16/2020
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