Provider Demographics
NPI:1508276213
Name:MADDOX, BENJAMIN
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:MADDOX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37236-0001
Mailing Address - Country:US
Mailing Address - Phone:615-284-2522
Mailing Address - Fax:
Practice Address - Street 1:2000 CHURCH STREET BOX 102-IP HOSPITALIST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37236-3403
Practice Address - Country:US
Practice Address - Phone:615-284-4672
Practice Address - Fax:615-284-5752
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN54405207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program