Individual
JUSTIN DERAY MADDOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAA
Contact information
Practice address
1364 CLIFTON RD NE, ATLANTA, GA 30322-1059
(404) 712-7100
Mailing address
PO BOX 723081, ATLANTA, GA 31139-0081
(770) 597-8817
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
9999
GA
367H00000X
Anesthesiologist Assistant
—
—
Other
Enumeration date
07/28/2020
Last updated
04/09/2026
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