Provider Demographics
NPI:1144710930
Name:PARTLOW, MARY G
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:G
Last Name:PARTLOW
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 1:805 N GREEN ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-2611
Mailing Address - Country:US
Mailing Address - Phone:662-840-9224
Mailing Address - Fax:662-840-4186
Practice Address - Street 1:805 N GREEN ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-2611
Practice Address - Country:US
Practice Address - Phone:662-840-9224
Practice Address - Fax:662-840-4186
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)