Priya Reddy Mallimala, M.B.B.S

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

T-5562 Issued in MS

Practice address

2500 North State Street
Jackson, MS 39216

Phone

(601) 984-1113

NPI assigned

May 7, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1715040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726704000000",
    "number": "1437907375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1703 HOWARD ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392021324",
            "telephone_number": "347-304-2127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 NORTH STATE STREET",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39216",
            "telephone_number": "601-984-1113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLIMALA",
        "first_name": "PRIYA",
        "middle_name": "REDDY",
        "name_prefix": "Ms.",
        "credential": "M.B.B.S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-07",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MS",
            "license": "T-5562",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Currier Mallette, M.D.
• Kathryn Hollis Mallette, M.D.
• Robert A Mallette, M.D.
• Malley Dental, PLLC
• Bradley James Malley, DMD
• Cassandra Malone
• Thomas Malone Jr., LMSW
• Virginia Henley Malone
• Ojus Malphurs
• Shana Shateka Mangum Holloman, MD

• Emergency Medicine Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Emergency Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.