Individual
MARLAH H MARDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1785 NONCONNAH BLVD, #120, MEMPHIS, TN 38132-2104
(901) 345-6700
(901) 345-6755
Mailing address
PO BOX 1000, DEPT. 96, MEMPHIS, TN 38148-0001
(901) 756-5565
(901) 756-5564
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25693
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3083714
—
TN
01
—
3092614
BCBST
TN
01
—
4597594
AETNA HMO
TN
01
—
4749410
CIGNA
TN
01
—
510081
UAHC/OMNICARE
TN
Enumeration date
09/01/2006
Last updated
06/25/2010
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