Healthcare Provider Details

I. General information

NPI: 1982756987
Provider Name (Legal Business Name): NELSON T. MADRAZO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 GA HIGHWAY 27 E
AMERICUS GA
31709-3800
US

IV. Provider business mailing address

103 GA HIGHWAY 27 E
AMERICUS GA
31709-3800
US

V. Phone/Fax

Practice location:
  • Phone: 229-924-8082
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NELSON MADRAZO
Title or Position: OWNER
Credential: M.D.
Phone: 229-924-8082