Active NPI
Marlah H Mardis, M.D.
- Family Medicine Physician
- Memphis, TN
National Provider Identifier
1326140237
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 25693
- Practice address
- 1785 Nonconnah Blvd
#120
Memphis, TN 38132-2104 - Phone
- (901) 345-6700
- Fax
- (901) 345-6755
- NPI assigned
- Sep 1, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 25693 | TN | Primary |
Addresses
Primary practice location
1785 Nonconnah Blvd
#120
Memphis, TN 38132-2104
Mailing address
PO Box 1000
Dept. 96
Memphis, TN 38148-0001
Phone (901) 756-5565
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4749410 | Other | TN | CIGNA |
| 510081 | Other | TN | UAHC/OMNICARE |
| 3083714 | Medicaid | TN | |
| 3092614 | Other | TN | BCBST |
| 4597594 | Other | TN | AETNA HMO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25693 | TN | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157068800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277424000000",
"number": "1326140237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1000",
"address_2": "DEPT. 96",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381480001",
"telephone_number": "901-756-5565",
"fax_number": "901-756-5564"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1785 NONCONNAH BLVD",
"address_2": "#120",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381322104",
"telephone_number": "901-345-6700",
"fax_number": "901-345-6755"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARDIS",
"first_name": "MARLAH",
"middle_name": "H",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-01",
"last_updated": "2010-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TN",
"license": "25693",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "4749410",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UAHC/OMNICARE",
"identifier": "510081",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3083714",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBST",
"identifier": "3092614",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO",
"identifier": "4597594",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.