Healthcare Provider Details

I. General information

NPI: 1497980536
Provider Name (Legal Business Name): GRADY EATON MADDOX M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 MEDICAL PARK DR E SUITE 255
BIRMINGHAM AL
35235-3400
US

IV. Provider business mailing address

833 SAINT VINCENTS DR BLDG. 3, SUITE 403
BIRMINGHAM AL
35205-1606
US

V. Phone/Fax

Practice location:
  • Phone: 205-838-3090
  • Fax: 205-838-3043
Mailing address:
  • Phone: 205-939-0447
  • Fax: 205-939-0418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD30657
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberMD30657
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: