Healthcare Provider Details

I. General information

NPI: 1679884316
Provider Name (Legal Business Name): MFON MALACHY INYANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 WINN WAY
DECATUR GA
30030-1707
US

IV. Provider business mailing address

500 W 3RD AVE SUITE 105
ALBANY GA
31701-1985
US

V. Phone/Fax

Practice location:
  • Phone: 404-294-3745
  • Fax:
Mailing address:
  • Phone: 229-312-7000
  • Fax: 229-312-7004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number73684
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number73684
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: