Kylisha J Mallard, AA

Primary specialty

Anesthesiologist AssistantTaxonomy code 367H00000X

License

4593 Issued in GA

Practice address

1968 Peachtree Road NW
Atlanta, GA 30309-1281

Phone

(404) 351-1745

Fax

(404) 351-7121

NPI assigned

Jul 19, 2006

Sex

Female

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

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Anesthesiology Assistant

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Piedmont Anesthesia LLCGroup PAC ID 2163837972, 555 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Piedmont Fayette Hospital Hospital, Fayetteville, GA, CCN 110215

Medicare enrollment (NPD)

Enrolled

Credentials

Associate of Arts, Physician Assistant

State licenses

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.

• Piedmont Anesthesia LLC

  • Anesthesiology Physician
  • Stockbridge, GA
  • NPI 1700474244

  GA

  Medicare reassignment Care Compare group NPD
• Capitol Anesthesiology, PC

  • Anesthesiology Physician
  • Morrow, GA
  • NPI 1245287192

  GA

  Medicare reassignment NPD
• Piedmont Anesthesia Associates, L.L.C

  • Anesthesiology Physician
  • Atlanta, GA
  • NPI 1407856594

  GA

  Medicare reassignment NPD
• Fayette Community Anesthesia

  • Anesthesiology Physician
  • Atlanta, GA
  • NPI 1144220245
  NPD (past)
• Resurgens Fayette Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Fayetteville, GA
  • NPI 1396298139
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Fayette Community Hospital, Inc.

  • General Acute Care Hospital
  • Fayetteville, GA
  • NPI 1528027240

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704758400000",
    "number": "1740200468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 551420",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333551420",
            "telephone_number": "800-243-3839",
            "fax_number": "954-839-2569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1968 PEACHTREE ROAD NW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303091281",
            "telephone_number": "404-351-1745",
            "fax_number": "404-351-7121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLARD",
        "first_name": "KYLISHA",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "AA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-19",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "0004593",
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "GA",
            "license": "4593",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "760751927C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hayley Elizabeth Malkin, MD, MPH
• Pamela Hayes Malkoff, MFT, ATR-BC, LPC,
• Geethika Naga Malla, DO
• Prerana Malla, MD
• Shailesh Malla, MD
• Laura W Mallard
• Beth A. Mallare, PT
• Jody Malleo, RD, LD, CDE
• Lillian Mallette, M.ED, NCC, APC
• Tarun Mallipeddi, MD

• All providers in Atlanta, GA
• Anesthesiologist Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.