Provider Demographics
NPI:1811131204
Name:MADDOX, LEIGH CATHERINE (APRN)
Entity type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:CATHERINE
Last Name:MADDOX
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 LAKEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-6693
Mailing Address - Country:US
Mailing Address - Phone:770-516-3557
Mailing Address - Fax:
Practice Address - Street 1:502 LAKEWOOD CT
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-6693
Practice Address - Country:US
Practice Address - Phone:678-910-4382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN168142NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily