Provider Demographics
NPI:1053323824
Name:MALAMIS, ROBERT BRADLEY (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRADLEY
Last Name:MALAMIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1800 HOWELL MILL ROAD
Mailing Address - Street 2:SUITE 175
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318
Mailing Address - Country:US
Mailing Address - Phone:404-607-1777
Mailing Address - Fax:404-607-1799
Practice Address - Street 1:1800 HOWELL MILL ROAD
Practice Address - Street 2:SUITE 175
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318
Practice Address - Country:US
Practice Address - Phone:404-607-1777
Practice Address - Fax:404-607-1799
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0423646207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00723379AMedicaid
G04124Medicare UPIN
GA11BDLNSMedicare ID - Type Unspecified