Provider Demographics
NPI:1851381321
Name:MALONE, MARIA (DPM)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 908325
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-0921
Mailing Address - Country:US
Mailing Address - Phone:770-533-9115
Mailing Address - Fax:770-533-9922
Practice Address - Street 1:691 LANIER PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2060
Practice Address - Country:US
Practice Address - Phone:770-533-9115
Practice Address - Fax:770-533-9922
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000832213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00820366AMedicaid
GA00820366AMedicaid
GA48SCBZGMedicare PIN