Individual
MR. MARCUS SAMUEL MADDOX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SLP
Contact information
Practice address
5967 CEDAR LN SW, MABLETON, GA 30126-3801
(678) 481-7209
(678) 669-2325
Mailing address
5967 CEDAR LN SW, MABLETON, GA 30126-3801
(678) 481-7209
(678) 669-2325
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP005885
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
379871475B
—
GA
05
—
379871475C
—
GA
Enumeration date
01/05/2006
Last updated
01/30/2024
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