Provider Demographics
NPI:1356315766
Name:MADDOX, SPENCER F III (MD)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:F
Last Name:MADDOX
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1429 OGLETHORPE ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-1512
Mailing Address - Country:US
Mailing Address - Phone:478-743-7061
Mailing Address - Fax:478-743-6296
Practice Address - Street 1:1429 OGLETHORPE ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1512
Practice Address - Country:US
Practice Address - Phone:478-743-7061
Practice Address - Fax:478-743-6296
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035691207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00509154BMedicaid
GA00509154BMedicaid
GA18BDCNQMedicare ID - Type Unspecified