Healthcare Provider Details

I. General information

NPI: 1245845569
Provider Name (Legal Business Name): MADISON RAE BROWNING PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 HOSPITAL BLVD STE 230
ROSWELL GA
30076-0001
US

IV. Provider business mailing address

2271 HUNTERS GREEN DR
LAWRENCEVILLE GA
30043-5182
US

V. Phone/Fax

Practice location:
  • Phone: 470-956-4560
  • Fax: 770-475-8968
Mailing address:
  • Phone: 678-977-5152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9844
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: