Provider Demographics
NPI:1174501555
Name:MALONE, PATRICK S (DPM)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:S
Last Name:MALONE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2589
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-2589
Mailing Address - Country:US
Mailing Address - Phone:888-821-1242
Mailing Address - Fax:888-325-0461
Practice Address - Street 1:620 J L WHITE DR STE 140B
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4896
Practice Address - Country:US
Practice Address - Phone:770-408-2039
Practice Address - Fax:888-325-0461
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000833213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00246419OtherMEDICARE RR
GA00800214AMedicaid
GA823527OtherBLUE CROSS BLUE SHIELD
GAP00246419OtherMEDICARE RR
GAU65332Medicare UPIN
GA48SCBZFMedicare ID - Type UnspecifiedMEDICARE
GA00800214AMedicaid