Healthcare Provider Details

I. General information

NPI: 1952212664
Provider Name (Legal Business Name): MADISON PARKER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4609 OAK ARBOR DR
VALDOSTA GA
31602-4900
US

IV. Provider business mailing address

4609 OAK ARBOR DR
VALDOSTA GA
31602-4900
US

V. Phone/Fax

Practice location:
  • Phone: 229-412-2000
  • Fax:
Mailing address:
  • Phone: 229-412-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP309293
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: