MEDICARE: MRS. JUAQULA MICHELLE MADKIN R.D., L.D., M.S.

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	133V00000X	Registered Dietitian	924890	AL

General Provider Information

NPI Number	:	1588604300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUAQULA MICHELLE MADKIN R.D., L.D., M.S.

Provider Business Mailing Address
First Line	:	304 EARNHARDT DR
Second Line	:
City	:	NEW MARKET
State	:	AL
Zip	:	35761-7917
Country	:	US
Telephone Number	:	256-829-1470
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 EARNHARDT DR
Second Line	:
City	:	NEW MARKET
State	:	AL
Zip	:	35761-7917
Country	:	US
Telephone Number	:	256-829-1470
Fax Number	:

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	09/19/2012

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