Healthcare Provider Details

I. General information

NPI: 1356598833
Provider Name (Legal Business Name): METROPOLITAN ATLANTA OB/GYN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 RAINBOW DR
DECATUR GA
30034-2302
US

IV. Provider business mailing address

4201 RAINBOW DR
DECATUR GA
30034-2302
US

V. Phone/Fax

Practice location:
  • Phone: 404-534-0035
  • Fax: 404-286-7100
Mailing address:
  • Phone: 404-534-0035
  • Fax: 404-286-7100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TYRONE C. MALLOY
Title or Position: OWNER
Credential: M.D.
Phone: 404-534-0035