Individual
REGINALD MARTINEZ MALONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
175 WHITE ST NW STE 100, MARIETTA, GA 30060-1054
(470) 793-0208
Mailing address
175 WHITE ST NW STE 100, MARIETTA, GA 30060-1054
(470) 793-0208
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
021986
NY
363A00000X
Physician Assistant
Primary
9381
GA
363AM0700X
Medical Physician Assistant
021986
NY
363AS0400X
Surgical Physician Assistant
021986
NY
Other
Enumeration date
04/10/2018
Last updated
08/07/2024
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