Individual
DR. SAMUEL JERMAINE MADDOX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1777 NORTHEAST EXPY NE, SUITE 175, ATLANTA, GA 30329-2480
(678) 523-0969
(770) 788-7662
Mailing address
1777 NORTHEAST EXPY NE, SUITE 175, ATLANTA, GA 30329-2480
(678) 523-0969
(770) 788-7662
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY002983
GA
103TC2200X
Clinical Child & Adolescent Psychologist
PSY002983
GA
103TF0000X
Family Psychologist
PSY002983
GA
103TM1800X
Intellectual & Developmental Disabilities Psychologist
PSY002983
GA
Other
Enumeration date
10/23/2007
Last updated
10/23/2007
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