Provider Demographics
NPI:1144009028
Name:MABONE, MILLICENT A
Entity type:Individual
Prefix:
First Name:MILLICENT
Middle Name:A
Last Name:MABONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 MCCORD HALL
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38152-5411
Mailing Address - Country:US
Mailing Address - Phone:901-678-2000
Mailing Address - Fax:
Practice Address - Street 1:215 MCCORD HALL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38152-3330
Practice Address - Country:US
Practice Address - Phone:901-366-3687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program