Healthcare Provider Details

I. General information

NPI: 1013871722
Provider Name (Legal Business Name): MALLORY ANN KUHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MALLORY OSLACKY

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 COLLIER RD NW
ATLANTA GA
30309-1709
US

IV. Provider business mailing address

955 JUNIPER ST NE UNIT 1314
ATLANTA GA
30309-5106
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-1002
  • Fax:
Mailing address:
  • Phone: 404-617-8881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13525
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: