Provider Demographics
NPI:1932802204
Name:MALIK, ANEEQ AHMED (PA-C)
Entity Type:Individual
Prefix:
First Name:ANEEQ
Middle Name:AHMED
Last Name:MALIK
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 1:217 BIRCHMORE WALK
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-4585
Mailing Address - Country:US
Mailing Address - Phone:678-315-5804
Mailing Address - Fax:
Practice Address - Street 1:367 ATHENS HWY STE 100A
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-2204
Practice Address - Country:US
Practice Address - Phone:678-466-6760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant