Healthcare Provider Details

I. General information

NPI: 1316985062
Provider Name (Legal Business Name): ANDREAS TIRSO MADDUX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 EDWARDS LAKE PKWY 204
BIRMINGHAM AL
35235-3117
US

IV. Provider business mailing address

3240 EDWARDS LAKE PKWY 204
BIRMINGHAM AL
35235-3117
US

V. Phone/Fax

Practice location:
  • Phone: 205-949-1414
  • Fax: 205-949-1415
Mailing address:
  • Phone: 205-702-6604
  • Fax: 205-949-1415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number00013482
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: