Provider Demographics
NPI:1366149866
Name:INGRAM WEEKS, MALINDA
Entity type:Individual
Prefix:
First Name:MALINDA
Middle Name:
Last Name:INGRAM WEEKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MALINDA
Other - Middle Name:
Other - Last Name:INGRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:759 SMYRNA RD SW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-5161
Mailing Address - Country:US
Mailing Address - Phone:404-914-8950
Mailing Address - Fax:
Practice Address - Street 1:759 SMYRNA RD SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5161
Practice Address - Country:US
Practice Address - Phone:404-914-8950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health