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General NPI Number Information
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NPI Number | 1669016747
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Entity Type | Individual
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Provider Name | KRISTINA MADDOX NP
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Gender | Female
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Dates
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Enumeration Date | 11/01/2019
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Last Update Date | 10/24/2021
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Provider Practice Location Address
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Address Line | 304 TURNER MCCALL BLVD SW
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City | ROME
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State | GA
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Zip | 30165-5621
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Country | US
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Telephone | 706-509-5000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2704
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City | ROME
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State | GA
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Zip | 30164-2704
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Country | US
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Telephone | 706-291-0291
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN176279
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License Number State | GA
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