Healthcare Provider Details

I. General information

NPI: 1912461518
Provider Name (Legal Business Name): MADIGAN CRITELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 KING GEORGE BLVD
SAVANNAH GA
31419-9547
US

IV. Provider business mailing address

PO BOX 253
SKILLMAN NJ
08558-0253
US

V. Phone/Fax

Practice location:
  • Phone: 912-788-8027
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-44667
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: