Most Relevant Information
Provider Data
| NPI Number: | 1003680976 |
| Provider Name: | MICHELLE MALVO |
| Entity Type: | Individual |
| Taxonomy Code: | 163WC0400X |
| Specialty: | Registered Nurse |
| License Number: | 169934 |
Most Important Dates
| Enumeration Date: | 11/13/2023 |
| Last Updated: | 11/13/2023 |
Provider Practice Location
544 MULBERRY PARK CIR
DACULA
GA
300192057
Practice Location Phone/Fax
| Phone: | 3478910266 |
| Fax: |
Provider Mailing Location
544 MULBERRY PARK CIR
DACULA
GA
300192057
Provider Mailing Phone/Fax
| Phone: | 3478910266 |
| Fax: |