Healthcare Provider Details

I. General information

NPI: 1760092134
Provider Name (Legal Business Name): ALICIA MALINDA DARBY-BISHOP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2020
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 UPPER RIVERDALE RD SW STE F
RIVERDALE GA
30274-2579
US

IV. Provider business mailing address

4700 NELSON BROGDON BLVD STE 220
BUFORD GA
30518-5401
US

V. Phone/Fax

Practice location:
  • Phone: 470-895-0610
  • Fax: 706-666-1325
Mailing address:
  • Phone: 770-904-9014
  • Fax: 770-904-9011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN234896
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: