Provider Demographics
NPI:1841430923
Name:MADDOX-WHITEHEAD, LILLIAN QUEVON (BSW)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:QUEVON
Last Name:MADDOX-WHITEHEAD
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 23RD AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-6301
Mailing Address - Country:US
Mailing Address - Phone:615-340-2261
Mailing Address - Fax:615-340-2195
Practice Address - Street 1:311 23RD AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1503
Practice Address - Country:US
Practice Address - Phone:615-340-2261
Practice Address - Fax:615-340-2195
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker