Provider Demographics
NPI:1215348990
Name:MALIK, MALIK M (MBBS)
Entity type:Individual
Prefix:
First Name:MALIK
Middle Name:M
Last Name:MALIK
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SATELLITE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-6211
Mailing Address - Country:US
Mailing Address - Phone:770-586-0300
Mailing Address - Fax:
Practice Address - Street 1:30 SATELLITE DR STE 200
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-6211
Practice Address - Country:US
Practice Address - Phone:770-586-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0081834207R00000X
NY390200000X
GA91665207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program