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Organization
TEMPLE MEDHEALTH
Active
Organization
TEMPLE MEDHEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BRANDERLY MALIWA NP (OWNER)
(765) 326-0148
Entity
Organization
Contact information
Practice address
503 MAIN ST, VILLA RICA, GA 30180-1931
(770) 462-1170
Mailing address
503 MAIN ST, VILLA RICA, GA 30180-1931
(770) 462-1170
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447790530
—
GA
Enumeration date
07/24/2019
Last updated
07/24/2019
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