Provider Demographics
NPI:1063708824
Name:MADDOCKS, JESSICA S
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:S
Last Name:MADDOCKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3437 HIAWATHA DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-2035
Mailing Address - Country:US
Mailing Address - Phone:706-617-7419
Mailing Address - Fax:
Practice Address - Street 1:3437 HIAWATHA DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-2035
Practice Address - Country:US
Practice Address - Phone:706-617-7419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator