Healthcare Provider Details

I. General information

NPI: 1093808057
Provider Name (Legal Business Name): ALAN MALOON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11650 ALPHARETTA HWY SUITE 100
ROSWELL GA
30076-3805
US

IV. Provider business mailing address

11650 ALPHARETTA HWY SUITE 100
ROSWELL GA
30076-3805
US

V. Phone/Fax

Practice location:
  • Phone: 470-365-8855
  • Fax: 404-301-4080
Mailing address:
  • Phone: 470-365-8855
  • Fax: 404-301-4080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number031470
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: