Healthcare Provider Details

I. General information

NPI: 1447516331
Provider Name (Legal Business Name): JULIA MALIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 06/12/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 APPLECROSS ROAD
SOUTHERN PINES NC
28388
US

IV. Provider business mailing address

145 APPLECROSS ROAD
SOUTHERN PINES NC
28388
US

V. Phone/Fax

Practice location:
  • Phone: 910-692-7928
  • Fax:
Mailing address:
  • Phone: 910-692-7928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number59922
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD044002
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2024-00224
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: