Samuel Jermaine Maddox, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY002983 Issued in GA

Practice address

1777 Northeast Expy NE
Suite 175
Atlanta, GA 30329-2480

Phone

(678) 523-0969

Fax

(770) 788-7662

NPI assigned

Oct 23, 2007

Last updated

Oct 23, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193097600000",
    "number": "1093904260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1777 NORTHEAST EXPY NE",
            "address_2": "SUITE 175",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303292480",
            "telephone_number": "678-523-0969",
            "fax_number": "770-788-7662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1777 NORTHEAST EXPY NE",
            "address_2": "SUITE 175",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303292480",
            "telephone_number": "678-523-0969",
            "fax_number": "770-788-7662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADDOX",
        "first_name": "SAMUEL",
        "middle_name": "JERMAINE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-23",
        "last_updated": "2007-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY002983",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "GA",
            "license": "PSY002983",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "GA",
            "license": "PSY002983",
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "GA",
            "license": "PSY002983",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Maddox, LMSW
• Justin Deray Maddox, CAA
• Kristie McMullen Maddox, M.ED., CCC-SLP
• Morgan Maddox, RBT
• Phyllicia Maddox, M.T.
• Taylor Maddox
• Kiran Kumar Maddu, M.B.B.S & M.D
• Madequest LLC
• McKenzie Grace Mader, RD
• Anita Madhavarao

• Clinical Psychologist in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Clinical Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.