MEDICARE: ANDREA LYNNE MALOY FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN203531	GA

General Provider Information

NPI Number	:	1447845243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA LYNNE MALOY FNP

Provider Business Mailing Address
First Line	:	1140 DERBY LN
Second Line	:
City	:	BOGART
State	:	GA
Zip	:	30622-5911
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 NEW HIGH SHOALS RD
Second Line	:
City	:	BISHOP
State	:	GA
Zip	:	30621-1305
Country	:	US
Telephone Number	:	706-769-7738
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2021
Last Update Date	:	12/04/2024

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