Provider Demographics
NPI:1669837845
Name:MADDOX, HANNAH J (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:J
Last Name:MADDOX
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:HANNAH
Other - Middle Name:J
Other - Last Name:MOULTRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6085 OLD TUSCALOOSA HWY
Mailing Address - Street 2:
Mailing Address - City:MC CALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35111-3509
Mailing Address - Country:US
Mailing Address - Phone:205-531-1911
Mailing Address - Fax:
Practice Address - Street 1:1300 BESSEMER RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35208-4326
Practice Address - Country:US
Practice Address - Phone:205-923-5555
Practice Address - Fax:205-923-5566
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-083792363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily