Provider Demographics
NPI:1235230822
Name:MALONE, MARY (CNM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 JESSE HILL JR DR SE
Mailing Address - Street 2:EMORY UNIVERSITY GYN/OB DEPT. 4TH FLOOR
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3033
Mailing Address - Country:US
Mailing Address - Phone:404-616-4898
Mailing Address - Fax:404-616-2904
Practice Address - Street 1:80 JESSE HILL JR DR SE # 26105
Practice Address - Street 2:GRADY HEALTH SYSTEM, GYN/OB CLINIC
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3031
Practice Address - Country:US
Practice Address - Phone:404-616-4898
Practice Address - Fax:404-616-2904
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN049304367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
2454OtherACNM CERTIFICATION NUMBER
GARN049304OtherRN LICENSE NUMBER-CNM
GA00507966AMedicaid
2454OtherACNM CERTIFICATION NUMBER
GARN049304OtherRN LICENSE NUMBER-CNM