Healthcare Provider Details

I. General information

NPI: 1235055963
Provider Name (Legal Business Name): MALISHA MISHOE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 DAWSON RD STE 105
ALBANY GA
31707-3867
US

IV. Provider business mailing address

2447 BASSFORD LN
ALBANY GA
31707-6689
US

V. Phone/Fax

Practice location:
  • Phone: 706-940-2138
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAPC011178
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: