Individual
KRISTIN LAUREN MALLORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1698 VERNON RD, LAGRANGE, GA 30240-4100
(706) 298-4937
(706) 812-4157
Mailing address
1698 VERNON RD, LAGRANGE, GA 30240-4100
(706) 298-4937
(706) 812-4157
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
RN236013
GA
363LF0000X
Family Nurse Practitioner
Primary
RN236013
GA
Other
Enumeration date
04/02/2021
Last updated
10/08/2024
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