Healthcare Provider Details

I. General information

NPI: 1407322134
Provider Name (Legal Business Name): MALI RICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2018
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 SYRACUSE LANE
COVINGTON GA
30016
US

IV. Provider business mailing address

105 SYRACUSE LANE
COVINGTON GA
30016
US

V. Phone/Fax

Practice location:
  • Phone: 648-677-1937
  • Fax:
Mailing address:
  • Phone: 648-677-1937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN175249
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: