Healthcare Provider Details

I. General information

NPI: 1831019397
Provider Name (Legal Business Name): MADISON DAWN BURNHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3657 PENNINGTON DR SE
CONYERS GA
30013-2946
US

IV. Provider business mailing address

3657 PENNINGTON DR SE
CONYERS GA
30013-2946
US

V. Phone/Fax

Practice location:
  • Phone: 678-360-2702
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMSW012449
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: