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General NPI Number Information
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NPI Number | 1093105793
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Entity Type | Individual
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Provider Name | BASMA MALIK
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Gender | Female
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Dates
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Enumeration Date | 02/02/2015
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 80 JESSE HILL JR DR SE
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City | ATLANTA
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State | GA
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Zip | 30303-3050
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Country | US
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Telephone | 404-616-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 148 BORTONS LANDING RD
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City | MOORESTOWN
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State | NJ
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Zip | 08057-3055
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Country | US
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Telephone | 609-257-8031
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 26NR23023900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | GAA-NP002919
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License Number State | GA
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