Active NPI
Angela Bostic-Maddox
- Physical Therapist
- Lawrenceville, GA
National Provider Identifier
1386280576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT003660
- Practice address
- 494 Lance View LN
Lawrenceville, GA 30045-8719 - Phone
- (404) 273-2830
- NPI assigned
- Nov 21, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT003660 | GA | Primary |
Addresses
Primary practice location
494 Lance View LN
Lawrenceville, GA 30045-8719
Mailing address
494 Lance View LN
Lawrenceville, GA 30045-8719
Phone (404) 273-2830
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT003660 | GA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1574294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574380800000",
"number": "1386280576",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "494 LANCE VIEW LN",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300458719",
"telephone_number": "404-273-2830"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "494 LANCE VIEW LN",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300458719",
"telephone_number": "404-273-2830"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOSTIC-MADDOX",
"first_name": "ANGELA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-11-21",
"last_updated": "2019-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "PT003660",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lawrenceville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.