Individual
LEA NICHOLE MADDOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
15855 19 MILE RD, CLINTON TOWNSHIP, MI 48038-3504
(319) 533-3200
Mailing address
1118 ROSS CLARK CIR STE 600, DOTHAN, AL 36301-3042
(334) 793-3900
(334) 793-5227
Taxonomy
Speciality
Code
Description
License number
State
207VX0000X
Obstetrics Physician
Primary
2863
AL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/27/2017
Last updated
07/10/2024
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