Healthcare Provider Details

I. General information

NPI: 1851381321
Provider Name (Legal Business Name): MARIA MALONE DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 LANIER PARK DR SUITE B
GAINESVILLE GA
30501-2060
US

IV. Provider business mailing address

PO BOX 908325
GAINESVILLE GA
30501-0921
US

V. Phone/Fax

Practice location:
  • Phone: 770-533-9115
  • Fax: 770-533-9922
Mailing address:
  • Phone: 770-533-9115
  • Fax: 770-533-9922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number000832
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000832
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: