Healthcare Provider Details

I. General information

NPI: 1144280066
Provider Name (Legal Business Name): DONNA SCHWARTZ MADDOX M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MEDICAL PARK RD SUITE 103
COLUMBIA SC
29203-8003
US

IV. Provider business mailing address

130 HIGHWAY 252
ANDERSON SC
29621-5054
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-4300
  • Fax: 803-255-3420
Mailing address:
  • Phone: 864-965-9826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number16574
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number16574
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: