Provider Demographics
NPI:1760850184
Name:MALONE, MARVA
Entity Type:Individual
Prefix:
First Name:MARVA
Middle Name:
Last Name:MALONE
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 1:6565 LAKE ESTHER DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-2774
Mailing Address - Country:US
Mailing Address - Phone:404-368-3490
Mailing Address - Fax:
Practice Address - Street 1:6565 LAKE ESTHER DR
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-2774
Practice Address - Country:US
Practice Address - Phone:404-368-3490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management