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General NPI Number Information
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NPI Number | 1528749645
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Entity Type | Individual
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Provider Name | MADDOX ABRAHAM LAWRENCE PHARMD.
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Gender | Male
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Dates
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Enumeration Date | 07/31/2023
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 1826 VETERANS BLVD
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City | DUBLIN
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State | GA
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Zip | 31021-3620
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Country | US
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Telephone | 478-272-1210
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Fax |
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Provider Business Mailing Address
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Address Line | 1826 VETERANS BLVD
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City | DUBLIN
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State | GA
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Zip | 31021-3620
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Country | US
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Telephone | 478-272-1210
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P1300X
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Taxonomy Name | Psychiatric Pharmacist
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License Number | 2022038048
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License Number State | MO
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