Old National OB- GYN, LLC

Primary specialty

Gynecology PhysicianTaxonomy code 207VG0400X

License

621111 Issued in GA

Legal business name

OLD NATIONAL OB- GYN, LLC

Practice address

6210 Old National Hwy
College Park, GA 30349-4330

Phone

(770) 991-7552

NPI assigned

Feb 22, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Tyrone C Malloy, M.D.

Title

Owner

Phone

(770) 991-7552

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272844800000",
    "number": "1851426878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6210 OLD NATIONAL HWY",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303494330",
            "telephone_number": "770-991-7552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6210 OLD NATIONAL HWY",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303494330",
            "telephone_number": "770-991-7552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD NATIONAL OB- GYN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2010-05-03",
        "status": "A",
        "authorized_official_last_name": "MALLOY",
        "authorized_official_first_name": "TYRONE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-991-7552",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "GA",
            "license": "621111",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00022741M",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Gynecology Physician in College Park, GA
• Providers in College Park, GA by specialty
• Gynecology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2010; 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.