Individual
MALLORY IRENE CHIANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 BLUE MOON XING STE 203, POOLER, GA 31322-9698
(912) 590-0973
(912) 590-0180
Mailing address
5191 FIRST COAST TECH PKWY FL 3, JACKSONVILLE, FL 32224-0609
(904) 256-2754
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
02/13/2024
Last updated
05/21/2024
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