Individual
JUSTIN CHAZ MALONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
830 S GLOSTER ST, TUPELO, MS 38801-4934
(662) 377-4394
Mailing address
PO BOX 3294, TUPELO, MS 38803-3294
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
901581
MS
Other
Enumeration date
09/13/2019
Last updated
09/13/2019
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