Provider Demographics
NPI:1710156104
Name:MADDEN, EDDIE M (RPH)
Entity Type:Individual
Prefix:
First Name:EDDIE
Middle Name:M
Last Name:MADDEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:EDDIE
Other - Middle Name:M
Other - Last Name:MADDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:101 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:ELBERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30635-1705
Mailing Address - Country:US
Mailing Address - Phone:706-283-1701
Mailing Address - Fax:706-283-1704
Practice Address - Street 1:101 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ELBERTON
Practice Address - State:GA
Practice Address - Zip Code:30635-1705
Practice Address - Country:US
Practice Address - Phone:706-283-1701
Practice Address - Fax:706-283-1704
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH010509183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist