Healthcare Provider Details

I. General information

NPI: 1780102012
Provider Name (Legal Business Name): BRITTANY NICOLE MALONE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 RANDOLPH RD STE 100
CHARLOTTE NC
28211-1051
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-367-4800
  • Fax: 704-316-3025
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-11161
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: