Healthcare Provider Details

I. General information

NPI: 1356635189
Provider Name (Legal Business Name): JAMES REID MALONE R.PH,CGP.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W PONCE DE LEON AVE 431
DECATUR GA
30030-3217
US

IV. Provider business mailing address

PO BOX 5911
ATLANTA GA
31107-0911
US

V. Phone/Fax

Practice location:
  • Phone: 404-275-9202
  • Fax:
Mailing address:
  • Phone: 404-377-9681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number12785
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: