Healthcare Provider Details

I. General information

NPI: 1558065805
Provider Name (Legal Business Name): ERIC PAUL MALANEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 MANCHESTER EXPY
COLUMBUS GA
31904-6878
US

IV. Provider business mailing address

4190 CITY AVE
PHILADELPHIA PA
19131-1626
US

V. Phone/Fax

Practice location:
  • Phone: 706-596-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number16730
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number16730
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: