Provider Demographics
NPI:1952669137
Name:MALONE, MARY ANNA
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANNA
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 1:105 CRESTWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-3108
Mailing Address - Country:US
Mailing Address - Phone:205-870-1099
Mailing Address - Fax:
Practice Address - Street 1:105 CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35213-3108
Practice Address - Country:US
Practice Address - Phone:205-870-1099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH-4554174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist