Provider Demographics
NPI:1730330028
Name:DUFFY, MARY ALEXIS (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ALEXIS
Last Name:DUFFY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 MCCALLIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2814
Mailing Address - Country:US
Mailing Address - Phone:423-322-6372
Mailing Address - Fax:205-268-4404
Practice Address - Street 1:255 S CREST RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-5522
Practice Address - Country:US
Practice Address - Phone:423-698-4211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-04
Last Update Date:2008-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMEDICAL TN012927171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor