Healthcare Provider Details

I. General information

NPI: 1306774591
Provider Name (Legal Business Name): TAYYIB MALIK D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 PONCE DE LEON AVE NE
ATLANTA GA
30308-2012
US

IV. Provider business mailing address

2479 OAK HILL OVERLOOK
DULUTH GA
30097-7412
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-2440
  • Fax:
Mailing address:
  • Phone: 404-574-3946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: