Individual
LYDIA MALLARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4575 NORTH SHALLOWFORD RD, DUNWOODY, GA 30338
(770) 454-4286
(770) 454-4065
Mailing address
PO BOX 70128, MARIETTA, GA 30007-0128
(770) 578-1800
(770) 578-6168
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN040329
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00556927B
—
GA
Enumeration date
06/28/2006
Last updated
07/08/2007
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