Individual
MRS. KYLISHA J MALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AA
Contact information
Practice address
1968 PEACHTREE ROAD NW, ATLANTA, GA 30309-1281
(404) 351-1745
(404) 351-7121
Mailing address
PO BOX 551420, FORT LAUDERDALE, FL 33355-1420
(800) 243-3839
(954) 839-2569
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0004593
GA
367H00000X
Anesthesiologist Assistant
Primary
4593
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
760751927C
—
GA
Enumeration date
07/19/2006
Last updated
01/09/2024
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