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General NPI Number Information
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NPI Number | 1578982716
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Entity Type | Individual
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Provider Name | WILLIAM CHRISTOPHER MALLON MD
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Gender | Male
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 8700 BEVERLY BLVD
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90048-1804
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Country | US
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Telephone | 310-423-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 901 N BROAD ST NE STE 120
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City | ROME
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State | GA
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Zip | 30161-5202
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Country | US
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Telephone | 706-291-2661
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 92381
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A167798
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License Number State | CA
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