Healthcare Provider Details

I. General information

NPI: 1376489583
Provider Name (Legal Business Name): MALCOLM THORPE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3376 ALHAMBRA CIR
HAMPTON GA
30228-3605
US

IV. Provider business mailing address

3376 ALHAMBRA CIR
HAMPTON GA
30228-3605
US

V. Phone/Fax

Practice location:
  • Phone: 718-536-6937
  • Fax:
Mailing address:
  • Phone: 718-536-6937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberRN329438
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: