Individual
MS. MALISSA NIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
4680
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
027147597B
—
GA
Enumeration date
06/19/2009
Last updated
05/29/2019
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