Mallory A. Booth, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

10676 Issued in GA

Practice address

1050 Ruby Tyler Pkwy
Tuscaloosa, AL 35404-2958

Phone

(478) 743-7068

Fax

(478) 741-1354

NPI assigned

May 18, 2016

Last updated

Jun 14, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southeastern Pain and Rehabilitation Physicians, PCGroup PAC ID 2264467505, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• DCH Regional Medical Center Hospital, Tuscaloosa, AL, CCN 010092
• Fayette Medical Center Hospital, Fayette, AL, CCN 010045

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southeastern Pain & Rehabilitation Physicians, PC

  • Pain Medicine Physician
  • Tuscaloosa, AL
  • NPI 1467446237
  Medicare reassignment Care Compare group
• Ear Nose and Throat Associates of

  • Otolaryngology/Facial Plastic Surgery Physician
  • Tuscaloosa, AL
  • NPI 1063838167
  Medicare reassignment

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Fayette Medical Center

  • General Acute Care Hospital
  • Fayette, AL
  • NPI 1851323836
  Care Compare affiliation
• The DCH Health Care Authority

  dba DCH Health & Wellness Clinic

  • Clinic/Center
  • Tuscaloosa, AL
  • NPI 1306613211

  Hospital

  Care Compare affiliation
• The DCH Health Care Authority

  dba DCH Outpatient Services

  • Clinic/Center
  • Tuscaloosa, AL
  • NPI 1780927681

  Hospital

  Care Compare affiliation
• The DCH Healthcare Authority

  dba DCH Regional Medical Center

  • General Acute Care Hospital
  • Tuscaloosa, AL
  • NPI 1841394418
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781395200000",
    "number": "1073960118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 RUBY TYLER PKWY",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354042958",
            "telephone_number": "205-759-7111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 RUBY TYLER PKWY",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354042958",
            "telephone_number": "478-743-7068",
            "fax_number": "478-741-1354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOTH",
        "first_name": "MALLORY",
        "middle_name": "A.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-18",
        "last_updated": "2026-06-14",
        "certification_date": "2026-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "10676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ramona Bonner, CRNP
• Louis Mitchell Bonnett
• George Michael Booker, CRNA
• Eric Ross Booth, DPT
• Kevin Booth
• Hugh M Borak, MD
• Emily Michelle Bosarge, PHARM.D.
• Alyssa Michelle Bosse, DPT
• Susan E. Bostick, M.D.
• Hugh Chester Boston Jr., M.D.

• Medical Physician Assistant in Tuscaloosa, AL
• Providers in Tuscaloosa, AL by specialty
• Medical Physician Assistant in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.