Healthcare Provider Details

I. General information

NPI: 1215870084
Provider Name (Legal Business Name): ASHLEY MALONE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 FISHER ST
BILOXI MS
39534-2508
US

IV. Provider business mailing address

4925 ASHBROOKE CT
CUMMING GA
30040-9092
US

V. Phone/Fax

Practice location:
  • Phone: 770-633-5811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN124180
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: