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General NPI Number Information
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NPI Number | 1972000404
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Entity Type | Individual
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Provider Name | MALAKA MUSTAFA
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Gender | Female
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Dates
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Enumeration Date | 04/11/2018
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 303 PARKWAY DR NE
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City | ATLANTA
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State | GA
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Zip | 30312
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Country | US
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Telephone | 404-265-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 219 BEAVER CREEK LN
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City | WOODSTOCK
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State | GA
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Zip | 30189-2552
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Country | US
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Telephone | 706-847-5252
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 8714
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License Number State | GA
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