Individual
DR. TARA S. MALLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
92 W. RATLIFF STREET, LUCEDALE, MS 39452-6537
(601) 947-8181
(601) 947-4411
Mailing address
PO BOX 1007, LUCEDALE, MS 39452-1007
(601) 947-8181
(601) 947-4411
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
13329
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0112990
—
MS
Enumeration date
08/16/2006
Last updated
01/06/2011
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