Healthcare Provider Details

I. General information

NPI: 1679837629
Provider Name (Legal Business Name): MALINDA TATIANA WEST M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

1215 WELLESLEY RD
MADISON WI
53705-2231
US

V. Phone/Fax

Practice location:
  • Phone: 706-724-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number67227
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number67227
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: