Healthcare Provider Details

I. General information

NPI: 1396454161
Provider Name (Legal Business Name): ALICE BARTRAM MADDUX PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S CAMERON ST
HILLSBOROUGH NC
27278-2505
US

IV. Provider business mailing address

2221 MANDY LN
HILLSBOROUGH NC
27278-7915
US

V. Phone/Fax

Practice location:
  • Phone: 919-732-9311
  • Fax:
Mailing address:
  • Phone: 919-812-6142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number527141
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1171830
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: