Provider Demographics
NPI:1912901844
Name:MALONEY, MICHAEL JAMES (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:MALONEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 COLLEGE AVE SE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-4510
Mailing Address - Country:US
Mailing Address - Phone:678-971-5005
Mailing Address - Fax:678-971-5009
Practice Address - Street 1:100 COLLEGE AVE SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-4510
Practice Address - Country:US
Practice Address - Phone:678-971-5005
Practice Address - Fax:678-971-5009
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024982207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00425389AMedicaid
GAD45996Medicare UPIN