Provider Demographics
NPI:1346263373
Name:MADDOX, NOTLEY GLAWSON JR (PA)
Entity Type:Individual
Prefix:MR
First Name:NOTLEY
Middle Name:GLAWSON
Last Name:MADDOX
Suffix:JR
Gender:M
Credentials:PA
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Mailing Address - Street 1:11507 RIVIERA CT
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1433
Mailing Address - Country:US
Mailing Address - Phone:804-748-9411
Mailing Address - Fax:
Practice Address - Street 1:1201 BROAD ROCK BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-0001
Practice Address - Country:US
Practice Address - Phone:804-675-5000
Practice Address - Fax:804-675-5223
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110001805363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant