Basic Information
| Provider Information | |||||||||
| NPI: | 1740423243 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MALIA | ||||||||
| FirstName: | VAN | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 14039 | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309190039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068639797 | ||||||||
| FaxNumber: | 7068607686 | ||||||||
| Practice Location | |||||||||
| Address1: | 3650 J DEWEY GRAY CIR | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309091867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068639797 | ||||||||
| FaxNumber: | 7068607686 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2009 | ||||||||
| LastUpdateDate: | 03/13/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | 070274 | GA | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 208100000X | 070274 | GA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.