Provider Demographics
NPI:1114283553
Name:AFFUEMBEY, MALOA CHU (MD)
Entity type:Individual
Prefix:DR
First Name:MALOA
Middle Name:CHU
Last Name:AFFUEMBEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MALOA
Other - Middle Name:
Other - Last Name:CHU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3050 FIVE FORKS TRICKUM RD SW STE D451
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-1810
Mailing Address - Country:US
Mailing Address - Phone:678-383-0463
Mailing Address - Fax:
Practice Address - Street 1:3050 FIVE FORKS TRICKUM RD SW STE D451
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-1810
Practice Address - Country:US
Practice Address - Phone:678-383-0463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA0749772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2199897Medicaid