Healthcare Provider Details

I. General information

NPI: 1093571374
Provider Name (Legal Business Name): MIA ALANA MALKIN AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 JOHNS CREEK PKWY STE B
SUWANEE GA
30024-1218
US

IV. Provider business mailing address

910 DEERFIELD CROSSING DR APT 11301
ALPHARETTA GA
30004-1841
US

V. Phone/Fax

Practice location:
  • Phone: 770-814-1260
  • Fax:
Mailing address:
  • Phone: 327-713-6404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number81587
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD004464
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: