Michael Mallory, MD, MPH

Primary specialty

Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X

License

046445 Issued in GA

Practice address

1001 Johnson Ferry Rd NE
Atlanta, GA 30342-1605

Phone

(404) 250-2972

NPI assigned

Apr 14, 2006

Last updated

Jan 30, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA, UT2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mmallory574613@direct.med.utah.edu

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Emergency Coverage, LLC

  dba Emergency Coverage Corporation of TeamHealth

  • Family Medicine Physician
  • Newport, TN
  • NPI 1427005008

  GA

  Medicare reassignment NPD
• Ihc Health Services Inc

  • Multi-Specialty Clinic/Center
  • Sandy, UT
  • NPI 1942325154
  Medicare reassignment NPD
• University of Utah Pediatric Acuity Care

  • Pediatric Critical Care Medicine Physician
  • Salt Lake City, UT
  • NPI 1619325131
  Medicare reassignment NPD
• University of Utah Pediatric Services

  dba Department of Pediatrics

  • Pediatrics Physician
  • Salt Lake City, UT
  • NPI 1487018974
  Medicare reassignment NPD
• Ihc Health Services Inc

  dba Dixon Clinic

  • Family Medicine Physician
  • Provo, UT
  • NPI 1841559648
  NPD
• Ihc Health Services, Inc.

  dba St George Adolescent Partial Hospitalization

  • Psychiatry Physician
  • St George, UT
  • NPI 1023843844
  NPD
• University of Utah Pediatric Acuity Care

  dba University of Utah Pediatric Palliative Care

  • Pediatric Hospice and Palliative Medicine Physician
  • Salt Lake City, UT
  • NPI 1851898365
  NPD
• University of Utah Pediatric Services

  dba Pediatric Infectious Disease

  • Pediatric Infectious Diseases Physician
  • Salt Lake City, UT
  • NPI 1285098855
  NPD
• University of Utah Pediatric Services

  dba Pediatric PM and R

  • Pediatric Rehabilitation Medicine Physician
  • Salt Lake City, UT
  • NPI 1477917045
  NPD
• University of Utah Pediatric Acuity Care

  dba Pediatric Emergency Medicine

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Salt Lake City, UT
  • NPI 1538523675
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1003870288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2133 KODIAK DR NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303454149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 JOHNSON FERRY RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421605",
            "telephone_number": "404-250-2972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLORY",
        "first_name": "MICHAEL",
        "credential": "MD, MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-14",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "UT",
            "license": "4928357-1205",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "GA",
            "license": "046445",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "497037753",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmallory574613@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jody Malleo, RD, LD, CDE
• Lillian Mallette, M.ED, NCC, APC
• Tarun Mallipeddi, MD
• Alexis Mallis
• Kristy Mallon
• Palen Powelson Mallory, M.D.
• Sharon Tyler Mallory, NP
• Jasmin Jelissa Malloy, CRNA
• Tiffany Malloy
• Pranava Mallu

• Pediatric Emergency Medicine (Pediatrics) Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Pediatric Emergency Medicine (Pediatrics) Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.