NPIMap

Individual provider Active NPI

William Olin Mallow, MD

  • Emergency Medicine Physician
  • Albany, GA
National Provider Identifier
1396793733
Registry record updated Aug 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
056900 Issued in GA
Practice address
803 N Jefferson St
Albany, GA 31701-2373
Phone
(229) 312-7800
NPI assigned
May 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2012

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 16019 SC
Family Medicine Physician 207Q00000X 16019 SC
Emergency Medicine Physician 207P00000X 056900 GA Primary

Addresses

Primary practice location

803 N Jefferson St
Albany, GA 31701-2373

Mailing address

2700 McCall CT
Albany, GA 31721-9193
Phone (864) 344-0265

Other identifiers 2

IdentifierTypeStateIssuer
003122498FMedicaidGA
160195MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Self Regional Healthcare Past Accepting new patients
Myung-Sup Kim MD PA Past Accepting new patients
Acs Primary Care Physicians - Southeast PC Emergency Medicine Past Accepting new patients
J Kim Radiology Associates PA Past Accepting new patients
Self Medical Group Past Accepting new patients

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1345075200000",
    "number": "1396793733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 MCCALL CT",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317219193",
            "telephone_number": "864-344-0265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 N JEFFERSON ST",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317012373",
            "telephone_number": "229-312-7800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLOW",
        "first_name": "WILLIAM",
        "middle_name": "OLIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-05",
        "last_updated": "2012-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "16019",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "16019",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "056900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003122498F",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "160195",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2012; 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.