Provider Demographics
NPI:1750059028
Name:MADDOX, ANNA G
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:G
Last Name:MADDOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 MOLTON CT APT 3
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1935
Mailing Address - Country:US
Mailing Address - Phone:478-787-1102
Mailing Address - Fax:
Practice Address - Street 1:2009 MOLTON CT APT 3
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-1935
Practice Address - Country:US
Practice Address - Phone:478-787-1102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program