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General NPI Number Information
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NPI Number | 1831597103
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Entity Type | Organization
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Legal Business Name | DR ANDREW MALINCHAK INC
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Dates
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Enumeration Date | 12/18/2014
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Last Update Date | 12/18/2014
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Provider Practice Location Address
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Address Line | 4128 HIGHWAY 278 NE
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City | COVINGTON
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State | GA
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Zip | 30014-2494
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Country | US
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Telephone | 770-788-9199
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Fax | 770-788-6774
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Provider Business Mailing Address
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Address Line | 4128 HIGHWAY 278 NE
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City | COVINGTON
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State | GA
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Zip | 30014-2494
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Country | US
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Telephone | 770-788-9199
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Fax | 770-788-6774
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ANDREW JAMES MALINCHAK
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Credential | DO
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Telephone | 770-788-9199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 044012
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License Number State | GA
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