Individual
JELICKA M MALLORY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5401 GUNBOAT DR # 17, COLUMBUS, GA 31907-1498
(706) 221-2626
Mailing address
5401 GUNBOAT DR # 17, COLUMBUS, GA 31907-1498
(706) 221-2626
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
—
GA
Other
Enumeration date
07/07/2025
Last updated
07/07/2025
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