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General NPI Number Information
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NPI Number | 1003310863
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Entity Type | Individual
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Provider Name | JOHN WILLIAM CARL CARTER MALLETT MD
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Gender | Male
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Dates
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Enumeration Date | 03/19/2018
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 1075 LAFAYETTE PKWY STE 100
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City | LAGRANGE
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State | GA
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Zip | 30241-3507
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Country | US
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Telephone | 706-443-5273
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Fax | 706-443-5275
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Provider Business Mailing Address
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Address Line | 1075 LAFAYETTE PKWY STE 100
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City | LAGRANGE
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State | GA
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Zip | 30241-3507
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Country | US
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Telephone | 706-443-5273
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Fax | 706-443-5275
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 95070
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 95070
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License Number State | GA
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