Healthcare Provider Details

I. General information

NPI: 1780297630
Provider Name (Legal Business Name): MELANIE BETH MADDOX FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 CAHABA BEACH RD
BIRMINGHAM AL
35242-5225
US

IV. Provider business mailing address

270 COUNTY ROAD 76
CENTRE AL
35960-8301
US

V. Phone/Fax

Practice location:
  • Phone: 205-421-2088
  • Fax: 205-278-7660
Mailing address:
  • Phone: 256-239-9337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN190286
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-106572
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: