Healthcare Provider Details

I. General information

NPI: 1104830181
Provider Name (Legal Business Name): MALA SHAYKHER KAUL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 COLLIER RD NW SUITE 2080
ATLANTA GA
30309-1764
US

IV. Provider business mailing address

77 COLLIER RD NW SUITE 2080
ATLANTA GA
30309-1764
US

V. Phone/Fax

Practice location:
  • Phone: 404-367-3350
  • Fax: 770-916-7602
Mailing address:
  • Phone: 404-367-3350
  • Fax: 770-916-7602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number076755
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: