Provider Demographics
NPI:1992773287
Name:MALONE, JOHN GREEN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:GREEN
Last Name:MALONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6602 WATERS AVE BLDG C
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2778
Mailing Address - Country:US
Mailing Address - Phone:912-354-7676
Mailing Address - Fax:912-503-2164
Practice Address - Street 1:6602 WATERS AVE BLDG C
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2778
Practice Address - Country:US
Practice Address - Phone:912-354-7676
Practice Address - Fax:912-503-2164
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94005682084N0400X
GA376062084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11618OtherPARTNERS MEDICARE
NC8954933Medicaid
NC54933OtherBLUE CROSS BLUE SHIELD
NC54933OtherBLUE CROSS BLUE SHIELD
NCNC9185AMedicare PIN