Individual
RONALD MALCOLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1712-A EAST BROAD AVENUE, ALBANY, GA 31705
(229) 639-3100
Mailing address
204 N WESTOVER BLVD, ALBANY, GA 31707-2983
(229) 888-6559
(229) 436-4107
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2081
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7169366
AETNA
GA
Enumeration date
09/05/2006
Last updated
07/08/2007
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