Healthcare Provider Details

I. General information

NPI: 1699883330
Provider Name (Legal Business Name): MICHELLE M MALONEY AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 SUWANEE DAM RD STE 200
SUWANEE GA
30024-1918
US

IV. Provider business mailing address

4320 SUWANEE DAM RD STE 200
SUWANEE GA
30024-1918
US

V. Phone/Fax

Practice location:
  • Phone: 404-297-4230
  • Fax: 678-710-9430
Mailing address:
  • Phone: 404-297-4230
  • Fax: 678-710-9430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1222
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD003817
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: