MEDICARE: THERESE A MAXWELL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	023637	GA

General Provider Information

NPI Number	:	1447231048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESE A MAXWELL MD

Provider Business Mailing Address
First Line	:	1504 N THORNTON AVE
Second Line	:	STE 102
City	:	DALTON
State	:	GA
Zip	:	30720-8394
Country	:	US
Telephone Number	:	706-226-0508
Fax Number	:	706-226-5889

Provider Business Practice Location Address
First Line	:	1504 N THORNTON AVE
Second Line	:	STE 102
City	:	DALTON
State	:	GA
Zip	:	30720-8394
Country	:	US
Telephone Number	:	706-226-0508
Fax Number	:	706-226-5889

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	07/08/2007

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Directions to “ THERESE A MAXWELL MD” Practice Location

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