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Individual
STANFORD JAMES MADDOX
Active
Individual
STANFORD JAMES MADDOX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
GA
261QP2000X
Physical Therapy Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
455255557
BUSINESS INFO
GA
Enumeration date
06/29/2018
Last updated
09/09/2020
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