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NPI Code Detail

MEDICARE: DR. AMANDA MALAYTER

MEDICARE:  DR. AMANDA  MALAYTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryDN013426GA

General Provider Information

NPI Number : 1942386867
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMANDA MALAYTER
Provider Business Mailing Address
First Line : 5044 BRENDLYNN DR
Second Line :
City : SUWANEE
State : GA
Zip : 30024-7656
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4458 JONESBORO RD
Second Line :
City : FOREST PARK
State : GA
Zip : 30297-4314
Country : US
Telephone Number : 678-904-6484
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2006
Last Update Date : 07/09/2007

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Directions to “ DR. AMANDA MALAYTER ” Practice Location

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