Individual
MICKYLE MADDIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
822 KAITLYN DR, LOGANVILLE, GA 30052-6929
(347) 613-0990
Mailing address
822 KAITLYN DR, LOGANVILLE, GA 30052-6929
(347) 613-0990
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/04/2024
Last updated
01/04/2024
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