Healthcare Provider Details

I. General information

NPI: 1366604167
Provider Name (Legal Business Name): MALLIKA THIRUPPATHI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BRADLEY LAKE BLVD
COLUMBUS GA
31904-3688
US

IV. Provider business mailing address

100 LAKERIDGE CT
COLUMBUS GA
31904-1800
US

V. Phone/Fax

Practice location:
  • Phone: 334-737-2737
  • Fax:
Mailing address:
  • Phone: 706-580-7071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number058517
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number058517
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number58517
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: