Healthcare Provider Details

I. General information

NPI: 1912901844
Provider Name (Legal Business Name): MICHAEL JAMES MALONEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 COLLEGE AVE SE
GAINESVILLE GA
30501-4510
US

IV. Provider business mailing address

100 COLLEGE AVE SE
GAINESVILLE GA
30501-4510
US

V. Phone/Fax

Practice location:
  • Phone: 678-971-5005
  • Fax: 678-971-5009
Mailing address:
  • Phone: 678-971-5005
  • Fax: 678-971-5009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number024982
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: