Provider Demographics
NPI:1457510646
Name:MADDOX, SHEILA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:ANN
Last Name:MADDOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 SAINT TAMMANY ST
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-9713
Mailing Address - Country:US
Mailing Address - Phone:205-613-9390
Mailing Address - Fax:
Practice Address - Street 1:402 SAINT TAMMANY ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-9713
Practice Address - Country:US
Practice Address - Phone:205-613-9390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018959207ZP0102X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology