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Individual

MALLIKARJUN SAMALA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1412 MILSTEAD AVE NE, CONYERS, GA 30012-3877
(770) 918-8079
Mailing address
11085 CALLAWAY DR, JOHNS CREEK, GA 30097-2622
(770) 800-3372

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
1093101511
LA
207Q00000X
Family Medicine Physician
Primary
79910
GA
208M00000X
Hospitalist Physician
79910
GA

Other

Enumeration date
04/10/2015
Last updated
11/25/2025
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