Healthcare Provider Details

I. General information

NPI: 1760968267
Provider Name (Legal Business Name): KAYLA MALDONADO BATCHELOR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLA RENE MALDONADO

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 S MAIN ST
MOULTRIE GA
31768-6925
US

IV. Provider business mailing address

PO BOX 2876
MOULTRIE GA
31776-2876
US

V. Phone/Fax

Practice location:
  • Phone: 229-502-9769
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number83956
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: