Provider Demographics
NPI:1457608796
Name:MALUCCI, AARON MICHAEL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:MICHAEL
Last Name:MALUCCI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 GREYFIELD LN
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-6338
Mailing Address - Country:US
Mailing Address - Phone:352-870-0823
Mailing Address - Fax:
Practice Address - Street 1:980 JOHNSON FY RD NE
Practice Address - Street 2:SUITE 940
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1626
Practice Address - Country:US
Practice Address - Phone:404-851-6000
Practice Address - Fax:404-252-2736
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106671363A00000X
GA6892363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006526500Medicaid
FL006526500Medicaid