Provider Demographics
NPI:1790465623
Name:MALLICK, HAANIYA (MS)
Entity Type:Individual
Prefix:
First Name:HAANIYA
Middle Name:
Last Name:MALLICK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 BRIDGE MILL DR SE APT F
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8367
Mailing Address - Country:US
Mailing Address - Phone:734-635-7319
Mailing Address - Fax:
Practice Address - Street 1:320 KENNESTONE HOSPITAL BLVD STE 216
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1140
Practice Address - Country:US
Practice Address - Phone:470-793-7472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS