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Individual

JUSTIN MARSHALL MALCOM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MSN, NP-C

Contact information

Practice address
3400 RIVERSIDE DR, MACON, GA 31210-2513
(478) 633-6644
(478) 633-4295
Mailing address
3400 RIVERSIDE DR, MACON, GA 31210-2513
(478) 474-5600
(478) 471-6769

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
230579
GA

Other

Enumeration date
07/01/2018
Last updated
09/28/2020
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