Amelia Ruth Malcom, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

171386 Issued in 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

Last updated

Aug 12, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1313107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313107200000",
    "number": "1376822965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 209",
            "city": "MADISON",
            "state": "GA",
            "postal_code": "306500209",
            "telephone_number": "706-752-0322",
            "fax_number": "706-752-0325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 S MAIN ST",
            "address_2": "SUITE 100",
            "city": "MADISON",
            "state": "GA",
            "postal_code": "306502033",
            "telephone_number": "706-752-0322",
            "fax_number": "706-752-0325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALCOM",
        "first_name": "AMELIA",
        "middle_name": "RUTH",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-12",
        "last_updated": "2011-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "171386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 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, PHARMD
• Michelle Dawn McCullough
• Inez Almeida McDaniel, LPC

• Family Nurse Practitioner in Madison, GA
• Providers in Madison, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2011; 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.