Healthcare Provider Details

I. General information

NPI: 1902809544
Provider Name (Legal Business Name): MADISON CLINIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 FRANKLIN RD
BRENTWOOD TN
37027-3280
US

IV. Provider business mailing address

330 FRANKLIN RD
BRENTWOOD TN
37027-3280
US

V. Phone/Fax

Practice location:
  • Phone: 615-309-3300
  • Fax: 615-309-3338
Mailing address:
  • Phone: 615-309-3300
  • Fax: 615-309-3338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateTN

VIII. Authorized Official

Name: BILL HUSSEY
Title or Position: PRESIDENT
Credential:
Phone: 615-465-7000