Provider Demographics
NPI:1568551919
Name:MALPARTIDA, JUAN CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLOS
Last Name:MALPARTIDA
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 1:1100 E WALNUT AVE STE 15
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-4185
Mailing Address - Country:US
Mailing Address - Phone:706-313-9091
Mailing Address - Fax:
Practice Address - Street 1:1100 E WALNUT AVE
Practice Address - Street 2:SUITE #15
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-4183
Practice Address - Country:US
Practice Address - Phone:706-259-5579
Practice Address - Fax:706-259-6558
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA50406207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA849865610AMedicaid
GA849865610AMedicaid