Healthcare Provider Details

I. General information

NPI: 1801080288
Provider Name (Legal Business Name): MADISON MEDICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 EATONTON RD
MADISON GA
30650-4627
US

IV. Provider business mailing address

PO BOX 209
MADISON GA
30650-0209
US

V. Phone/Fax

Practice location:
  • Phone: 706-752-0322
  • Fax: 706-752-0325
Mailing address:
  • Phone: 706-752-0322
  • Fax: 706-752-0325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateGA

VIII. Authorized Official

Name: DAVID T FLETCHER
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 706-752-0322