Provider Demographics
NPI:1730358227
Name:MADDUX, DAVIS H (BS, RTR, RDMS,RVT)
Entity type:Individual
Prefix:MR
First Name:DAVIS
Middle Name:H
Last Name:MADDUX
Suffix:
Gender:M
Credentials:BS, RTR, RDMS,RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BONTWELL CIR
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6538
Mailing Address - Country:US
Mailing Address - Phone:843-301-2224
Mailing Address - Fax:
Practice Address - Street 1:5 BONTWELL CIR
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6538
Practice Address - Country:US
Practice Address - Phone:843-301-2224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC199483247100000X
SC796452471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist