1457608796 NPI number — MR. AARON MICHAEL MALUCCI PA-C

Table of content: MR. AARON MICHAEL MALUCCI PA-C (NPI 1457608796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457608796 NPI number — MR. AARON MICHAEL MALUCCI PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALUCCI
Provider First Name:
AARON
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457608796
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1624 GREYFIELD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDY SPRINGS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30350-6338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-870-0823
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
980 JOHNSON FY RD NE
Provider Second Line Business Practice Location Address:
SUITE 940
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30342-1626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-851-6000
Provider Business Practice Location Address Fax Number:
404-252-2736
Provider Enumeration Date:
08/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA9106671 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 6892 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 006526500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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