Healthcare Provider Details

I. General information

NPI: 1174749865
Provider Name (Legal Business Name): CHRISTINA ENTREKIN MADDOX MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA ELAINE ENTREKIN

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 BROOKWOOD MEDICAL CTR DR STE 310
BIRMINGHAM AL
35209-6823
US

IV. Provider business mailing address

3500 BLUE LAKE DR STE 495
VESTAVIA AL
35243-1975
US

V. Phone/Fax

Practice location:
  • Phone: 205-877-2121
  • Fax: 205-877-2569
Mailing address:
  • Phone: 800-257-6570
  • Fax: 205-599-4287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number61123
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberRTP000471
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number34771
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: