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General NPI Number Information
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NPI Number | 1750824322
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Entity Type | Individual
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Provider Name | PAULINE JAMES MADDOX AGNP
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Gender | Female
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Dates
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Enumeration Date | 11/29/2016
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Last Update Date | 11/29/2016
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Provider Practice Location Address
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Address Line | 499 FIELDS FERRY DR NE
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City | CALHOUN
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State | GA
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Zip | 30701-5900
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Country | US
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Telephone | 954-439-0114
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Fax |
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Provider Business Mailing Address
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Address Line | 499 FIELDS FERRY DR NE
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City | CALHOUN
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State | GA
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Zip | 30701-5900
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Country | US
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Telephone | 954-439-0114
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN229785
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License Number State | GA
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