Provider Demographics
NPI:1992802342
Name:MALAVER-REYES, JIMMY ARTURO (MD)
Entity type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:ARTURO
Last Name:MALAVER-REYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JIMMY
Other - Middle Name:ARTURO
Other - Last Name:MALAVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:214 PROFESSIONAL CIR STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-3783
Mailing Address - Country:US
Mailing Address - Phone:912-510-8224
Mailing Address - Fax:912-576-4791
Practice Address - Street 1:214 PROFESSIONAL CIR STE A
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3783
Practice Address - Country:US
Practice Address - Phone:787-605-8830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA65138208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice