Provider Demographics
NPI:1780297630
Name:MADDOX, MELANIE BETH (FNP-BC)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:BETH
Last Name:MADDOX
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 COUNTY ROAD 76
Mailing Address - Street 2:
Mailing Address - City:CENTRE
Mailing Address - State:AL
Mailing Address - Zip Code:35960-8301
Mailing Address - Country:US
Mailing Address - Phone:256-239-9337
Mailing Address - Fax:
Practice Address - Street 1:3700 CAHABA BEACH RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-5225
Practice Address - Country:US
Practice Address - Phone:205-421-2088
Practice Address - Fax:205-278-7660
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN190286363L00000X
AL1-106572363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL63-0825248Medicaid