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Individual
AUDREY JANE I MADDOX
Active
Individual
AUDREY JANE I MADDOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
067679
GA
208000000X
Pediatrics Physician
LL31769
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
067679
GA COMPOSITE MEDICAL BOARD
GA
Enumeration date
07/02/2009
Last updated
08/13/2012
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