Provider Demographics
NPI:1003538513
Name:MALLOY, ASHBY EMMALYN (PA-C)
Entity Type:Individual
Prefix:
First Name:ASHBY
Middle Name:EMMALYN
Last Name:MALLOY
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:381 PINE FOREST RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2759
Mailing Address - Country:US
Mailing Address - Phone:404-317-7177
Mailing Address - Fax:
Practice Address - Street 1:3200 DOWNWOOD CIR NW STE 700
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-5308
Practice Address - Country:US
Practice Address - Phone:404-355-8066
Practice Address - Fax:844-311-7739
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant