Amelia Ruth Malcom, APRN
Individual provider Active NPI Family Nurse Practitioner · Madison, GA
NPI 1376822965 · NPPES record last updated Aug 12, 2011
Key facts
- NPI
- 1376822965
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 171386 (GA)
- Practice address
- 1075 S Main St
Suite 100
Madison, GA 30650-2033 - Phone
- (706) 752-0322
- Fax
- (706) 752-0325
- NPI assigned
- Aug 12, 2011
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 171386 | GA | MD | Family Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 171386 | GA | Yes |
Addresses
Primary practice location
1075 S Main St
Suite 100
Madison, GA 30650-2033
Mailing address
PO Box 209
Madison, GA 30650-0209
Phone (706) 752-0322
Other providers in Madison, GA
- Madison Family Medicine,LLP
- Madison House Assisted Living
- Madison Medical Associates, PC
- Madison Primary Care, LLC
- Madisondentalgroupllc
- Kelly Lynn Martin
- Kaylie McAllister
- Kelli Bass McCarty
- Michelle Dawn McCullough
- Davis Edward McHugh
All providers in Madison, GA · Family Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 12, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.