Healthcare Provider Details

I. General information

NPI: 1457099053
Provider Name (Legal Business Name): MADISON SCHMIDT AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5414 SKIDAWAY RD
SAVANNAH GA
31406-2248
US

IV. Provider business mailing address

2200 OLD QUACCO RD APT 3308
POOLER GA
31322-0638
US

V. Phone/Fax

Practice location:
  • Phone: 912-355-4601
  • Fax:
Mailing address:
  • Phone: 330-421-8166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAUD004322
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD004322
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: