Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 031470 | GA |
NPI | 1093808057 |
---|---|
Provider Name | Mr. Alan Maloon |
First Address | Roswell, GA 30076-3805 |
Second Address | Roswell, GA 30076-3805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 03/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F02894 | (02) |