Provider Demographics
NPI:1770558470
Name:ABDELMALIK, MAGED EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:MAGED
Middle Name:EDWARD
Last Name:ABDELMALIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MAGED
Other - Middle Name:EDWARD
Other - Last Name:ABDELMALIK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2383 THIRD ST
Mailing Address - Street 2:
Mailing Address - City:FOLKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:31537-8917
Mailing Address - Country:US
Mailing Address - Phone:912-496-2697
Mailing Address - Fax:912-496-1139
Practice Address - Street 1:2383 THIRD ST
Practice Address - Street 2:
Practice Address - City:FOLKSTON
Practice Address - State:GA
Practice Address - Zip Code:31537-8917
Practice Address - Country:US
Practice Address - Phone:912-496-2697
Practice Address - Fax:912-496-1139
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA55077207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA140269228AMedicaid
GA140269228AMedicaid