Provider Demographics
NPI:1336615194
Name:THURMOND MALONE, MYRNA (CPC)
Entity Type:Individual
Prefix:DR
First Name:MYRNA
Middle Name:
Last Name:THURMOND MALONE
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 AMBERLEIGH LN
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-4682
Mailing Address - Country:US
Mailing Address - Phone:404-552-3829
Mailing Address - Fax:
Practice Address - Street 1:710 KING RD
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2027
Practice Address - Country:US
Practice Address - Phone:770-468-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral