Provider Demographics
NPI:1992702021
Name:MABRY, ELIZABETH D (MD)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:D
Last Name:MABRY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1210 PREMIER DR STE 110
Mailing Address - Street 2:THE POINTE
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3747
Mailing Address - Country:US
Mailing Address - Phone:423-385-2020
Mailing Address - Fax:423-385-2021
Practice Address - Street 1:1210 PREMIER DR STE 110
Practice Address - Street 2:THE POINTE
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3747
Practice Address - Country:US
Practice Address - Phone:423-385-2020
Practice Address - Fax:423-385-2021
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2023-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD 28309207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3084305Medicaid
TN3804305Medicare ID - Type Unspecified
TN3084305Medicaid