Rodney Mallory

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

2300 W Park PL Ste 135
Stone Mountain, GA 30087-3561

Phone

(678) 330-1400

Fax

(678) 330-1405

NPI assigned

Dec 23, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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

• The Potter'S House Family and Children Treatment Center

  • Adolescent and Children Mental Health Clinic/Center
  • Stone Mountain, GA
  • NPI 1326230020
  NPD

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

{
    "created_epoch": "1608681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608681600000",
    "number": "1194312108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5665 SOUTHLAND DR",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300875272",
            "telephone_number": "678-478-2559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 W PARK PL STE 135",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873561",
            "telephone_number": "678-330-1400",
            "fax_number": "678-330-1405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLORY",
        "first_name": "RODNEY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-12-23",
        "last_updated": "2020-12-23",
        "certification_date": "2020-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Counselor in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.