Provider Demographics
NPI:1750824322
Name:MADDOX, PAULINE JAMES (AGNP)
Entity Type:Individual
Prefix:MRS
First Name:PAULINE
Middle Name:JAMES
Last Name:MADDOX
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 FIELDS FERRY DR NE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-5900
Mailing Address - Country:US
Mailing Address - Phone:954-439-0114
Mailing Address - Fax:
Practice Address - Street 1:499 FIELDS FERRY DR NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-5900
Practice Address - Country:US
Practice Address - Phone:954-439-0114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN229785363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health