Provider Demographics
NPI:1306052477
Name:ROBERT J MADDEN MD PC
Entity type:Organization
Organization Name:ROBERT J MADDEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-295-7320
Mailing Address - Street 1:14 JOHN MADDOX DR NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1450
Mailing Address - Country:US
Mailing Address - Phone:706-295-7320
Mailing Address - Fax:706-295-7319
Practice Address - Street 1:14 JOHN MADDOX DR NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1450
Practice Address - Country:US
Practice Address - Phone:706-295-7320
Practice Address - Fax:706-295-7319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022825207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA85000273GMedicaid
GAGRP1340Medicare ID - Type Unspecified