Healthcare Provider Details

I. General information

NPI: 1427396142
Provider Name (Legal Business Name): SABRINA MADISON BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2013
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 BRAMBLE BUSH TRL
COVINGTON GA
30014-5972
US

IV. Provider business mailing address

175 CHEYENNE DR
COVINGTON GA
30016-6608
US

V. Phone/Fax

Practice location:
  • Phone: 770-670-0540
  • Fax:
Mailing address:
  • Phone: 770-670-0540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN225272
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN225272
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN225272
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN225272
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: