Basic Information
Provider Information
NPI: 1215927165
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MALIK
FirstName: SALEEM
MiddleName: N
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1700 HOSPITAL SOUTH DR
Address2: SUITE 500
City: AUSTELL
State: GA
PostalCode: 301066810
CountryCode: US
TelephoneNumber: 7709417717
FaxNumber: 7709489729
Practice Location
Address1: 1700 HOSPITAL SOUTH DR
Address2: SUITE 500
City: AUSTELL
State: GA
PostalCode: 301066810
CountryCode: US
TelephoneNumber: 7709417717
FaxNumber: 7709489729
Other Information
ProviderEnumerationDate: 10/24/2005
LastUpdateDate: 08/27/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X044523GAY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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