Individual
JEREMIAH J MADDOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 ROSS CLARK CIR, DOTHAN, AL 36301-4754
(334) 793-2663
(334) 836-2248
Mailing address
PO BOX 729, DOTHAN, AL 36302-0729
(334) 793-2663
(334) 836-2248
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
27935
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003112729A
—
GA
05
—
003112729B
—
GA
01
—
1245449800
MEDICARE ID
AL
05
—
130085
—
AL
05
—
130087
—
AL
01
—
511-17847
BCBS OF AL - RCC
AL
01
—
511-18371
BCBS OF AL - HEALTHWEST
AL
Enumeration date
05/21/2007
Last updated
11/20/2014
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