Provider Demographics
NPI:1427162338
Name:GEORGE STEVEN MALONE, O.D.P.C.
Entity type:Organization
Organization Name:GEORGE STEVEN MALONE, O.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-626-7249
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37879-0430
Mailing Address - Country:US
Mailing Address - Phone:423-626-7249
Mailing Address - Fax:423-626-6630
Practice Address - Street 1:114 IRISH CEMETERY RD
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879
Practice Address - Country:US
Practice Address - Phone:423-626-7249
Practice Address - Fax:423-626-6630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNT792152W00000X
TN1575152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3594654Medicaid
TN3594654Medicaid
TN3599952Medicare PIN
TN0884630001Medicare NSC