Provider Demographics
NPI:1043421084
Name:O'MALLEY, MARGARET ANN (RN,CACII)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:ANN
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:RN,CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 MADISON CHASE DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-8547
Mailing Address - Country:US
Mailing Address - Phone:678-377-1943
Mailing Address - Fax:678-729-9904
Practice Address - Street 1:215 KIRKLAND RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-3318
Practice Address - Country:US
Practice Address - Phone:678-729-9900
Practice Address - Fax:678-729-9904
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN090889163WA0400X
GA0826101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)