Provider Demographics
NPI:1578232500
Name:GADDIS, MALIA
Entity Type:Individual
Prefix:
First Name:MALIA
Middle Name:
Last Name:GADDIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MARY ALICE PARK RD STE 302
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2683
Mailing Address - Country:US
Mailing Address - Phone:443-414-1843
Mailing Address - Fax:
Practice Address - Street 1:102 MARY ALICE PARK RD STE 302
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2683
Practice Address - Country:US
Practice Address - Phone:443-414-1843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst