Individual
MALLORY A. BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
800 1ST ST STE 410, MACON, GA 31201-8306
(478) 743-7068
(478) 741-1354
Mailing address
800 1ST ST STE 410, MACON, GA 31201-8306
(478) 743-7068
(478) 741-1354
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
10676
GA
Other
Enumeration date
05/18/2016
Last updated
05/06/2026
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