Basic Information
| Provider Information | |||||||||
| NPI: | 1780297630 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MADDOX | ||||||||
| FirstName: | MELANIE | ||||||||
| MiddleName: | BETH | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 270 COUNTY ROAD 76 | ||||||||
| Address2: | |||||||||
| City: | CENTRE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359608301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562399337 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3700 CAHABA BEACH RD | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352425225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2054212088 | ||||||||
| FaxNumber: | 2052787660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2020 | ||||||||
| LastUpdateDate: | 08/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 1-106572 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 63-0825248 | 05 | AL | MEDICAID |