Provider Demographics
NPI:1467010496
Name:MALIN, JOEL DON
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:DON
Last Name:MALIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 WALTON WAY
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31639-6456
Mailing Address - Country:US
Mailing Address - Phone:731-636-0140
Mailing Address - Fax:
Practice Address - Street 1:3790 OLD US HIGHWAY 41 N
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6864
Practice Address - Country:US
Practice Address - Phone:229-262-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006347101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health