| Ellen L Malone Sole Mbr | |
|
1408 Highway 90 Suite 2 Gautier MS 39553-5456 | |
| (228) 497-8180 | |
| (228) 497-6594 |
| Full Name | Ellen L Malone Sole Mbr |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1408 Highway 90, Gautier, Mississippi |
| Authorized Official Name and Position | Ellen L Malone (OWER/SOLE MBR) |
| Authorized Official Contact | 2284978180 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellen L Malone Sole Mbr Po Box 1512 Gautier MS 39553-0019 Ph: (228) 497-8180 | Ellen L Malone Sole Mbr 1408 Highway 90 Suite 2 Gautier MS 39553-5456 Ph: (228) 497-8180 |
| NPI Number | 1952548059 |
|---|---|
| Provider Enumeration Date | 01/12/2009 |
| Last Update Date | 08/29/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952548059 | NPI | - | NPPES |
| 07933592 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | C2571 (Mississippi) | Primary |
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