MEDICARE: KIMBERLY MADISON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier		GA

General Provider Information

NPI Number	:	1578401816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY MADISON

Provider Business Mailing Address
First Line	:	908 CREEL LN
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-5189
Country	:	US
Telephone Number	:	888-276-9635
Fax Number	:

Provider Business Practice Location Address
First Line	:	908 CREEL LN
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-5189
Country	:	US
Telephone Number	:	888-276-9635
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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Directions to “ KIMBERLY MADISON ” Practice Location

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