Provider Demographics
NPI:1295900090
Name:RAJOURIA-MALLA, NAMITA (MD)
Entity type:Individual
Prefix:DR
First Name:NAMITA
Middle Name:
Last Name:RAJOURIA-MALLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 APPLEWOOD DR
Mailing Address - Street 2:STE 1
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2699
Mailing Address - Country:US
Mailing Address - Phone:706-270-5003
Mailing Address - Fax:706-270-5111
Practice Address - Street 1:650 JOE FRANK HARRIS PARKWAY
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3962
Practice Address - Country:US
Practice Address - Phone:770-387-3538
Practice Address - Fax:770-607-6704
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0557912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry