Provider Demographics
NPI:1609922806
Name:CUNNINGHAM, MALCOM (MD)
Entity Type:Individual
Prefix:
First Name:MALCOM
Middle Name:
Last Name:CUNNINGHAM
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 1:1696 COUNTY ROAD 39
Mailing Address - Street 2:
Mailing Address - City:FACKLER
Mailing Address - State:AL
Mailing Address - Zip Code:35746-4909
Mailing Address - Country:US
Mailing Address - Phone:904-687-3213
Mailing Address - Fax:
Practice Address - Street 1:1696 COUNTY ROAD 39
Practice Address - Street 2:
Practice Address - City:FACKLER
Practice Address - State:AL
Practice Address - Zip Code:35746-4909
Practice Address - Country:US
Practice Address - Phone:904-687-3213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL451192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG72147DMedicare ID - Type Unspecified