Individual
BRIANA MARIE MADDIX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
822 KAITLYN DR, LOGANVILLE, GA 30052-6929
(347) 649-4940
Mailing address
822 KAITLYN DR, LOGANVILLE, GA 30052-6929
(347) 649-4940
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
057021701
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
057021701
DRIVERS LICENSE
GA
Enumeration date
03/08/2022
Last updated
03/08/2022
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