Individual
RENEE R MADDUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4005 CANTON RD, MARIETTA, GA 30066-2739
(770) 728-8833
(678) 668-7469
Mailing address
4005 CANTON RD, MARIETTA, GA 30066-2739
(770) 728-8833
(678) 668-7469
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
6052
GA
2251P0200X
Pediatric Physical Therapist
Primary
6052
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10040447
AMERIGROUP
GA
01
—
321993
WELLCARE
GA
01
—
6052
PHYSICAL THERAPY LICENSE
GA
Enumeration date
12/11/2006
Last updated
03/18/2025
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