Individual
JACQUELINE A. MALLOY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
101 RIVERSTONE VIS, BLUE RIDGE, GA 30513-6648
(706) 258-4400
(706) 632-3585
Mailing address
804 WATERFORD ESTATES MNR, CANTON, GA 30114-9422
(770) 704-1995
(706) 632-3585
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
1159783
TX
363L00000X
Nurse Practitioner
80435
NM
363L00000X
Nurse Practitioner
ARNP 9164727
FL
363LF0000X
Family Nurse Practitioner
Primary
ARNP 103102
GA
Other
Enumeration date
05/18/2006
Last updated
10/04/2024
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