Provider Demographics
NPI:1437388220
Name:MADDOX, JILL M (NP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:MADDOX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2725 IRON GATE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-3732
Mailing Address - Country:US
Mailing Address - Phone:910-909-4242
Mailing Address - Fax:910-660-8086
Practice Address - Street 1:2725 IRON GATE DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-3732
Practice Address - Country:US
Practice Address - Phone:910-909-4242
Practice Address - Fax:910-660-8086
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5020472207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000973275OtherBCBS BMG IRELAND
INP01672697OtherRR MEDICARE
IN000000973275OtherBCBS BMG IRELAND