Provider Demographics
NPI:1225256381
Name:MADDOX, BILL FRANKLIN JR (DO)
Entity Type:Individual
Prefix:
First Name:BILL
Middle Name:FRANKLIN
Last Name:MADDOX
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:867 HIGHWAY 1 S
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-5963
Mailing Address - Country:US
Mailing Address - Phone:662-378-0283
Mailing Address - Fax:662-332-3316
Practice Address - Street 1:867 HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-5963
Practice Address - Country:US
Practice Address - Phone:662-378-0283
Practice Address - Fax:662-332-3316
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2010-01-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS11843207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS080001345Medicare ID - Type Unspecified
MSD80559Medicare UPIN