Healthcare Provider Details

I. General information

NPI: 1942133350
Provider Name (Legal Business Name): WILLIAM MADDEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 CREEK RIDGE RD TRLR 53
GREENSBORO NC
27406-4819
US

IV. Provider business mailing address

724 CREEK RIDGE RD TRLR 53
GREENSBORO NC
27406-4819
US

V. Phone/Fax

Practice location:
  • Phone: 336-490-1115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: