Provider Demographics
NPI:1356635189
Name:MALONE, JAMES REID (RPH,CGP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:REID
Last Name:MALONE
Suffix:
Gender:M
Credentials:RPH,CGP
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 5911
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31107-0911
Mailing Address - Country:US
Mailing Address - Phone:404-377-9681
Mailing Address - Fax:
Practice Address - Street 1:201 W PONCE DE LEON AVE
Practice Address - Street 2:431
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3217
Practice Address - Country:US
Practice Address - Phone:404-275-9202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA127851835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric