Provider Demographics
NPI:1093808057
Name:MALOON, ALAN (MD)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:
Last Name:MALOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11650 ALPHARETTA HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-3805
Mailing Address - Country:US
Mailing Address - Phone:470-365-8855
Mailing Address - Fax:404-301-4080
Practice Address - Street 1:11650 ALPHARETTA HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-3805
Practice Address - Country:US
Practice Address - Phone:470-365-8855
Practice Address - Fax:404-301-4080
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031470204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
13BDBBDMedicare ID - Type Unspecified
F02894Medicare UPIN