Healthcare Provider Details

I. General information

NPI: 1710716410
Provider Name (Legal Business Name): MALOMS GROUP INTERNATIONAL, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3546 VIEWS TRCE
NORCROSS GA
30092-4505
US

IV. Provider business mailing address

3546 VIEWS TRCE
NORCROSS GA
30092-4505
US

V. Phone/Fax

Practice location:
  • Phone: 470-914-5449
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEVIN MALOMS
Title or Position: MANAGER
Credential:
Phone: 470-914-5449