Healthcare Provider Details

I. General information

NPI: 1598131252
Provider Name (Legal Business Name): MADISON THOMASON MS, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 CENTRAL AVE
CHATTANOOGA TN
37403-1503
US

IV. Provider business mailing address

102 CENTRAL AVE
CHATTANOOGA TN
37403-1503
US

V. Phone/Fax

Practice location:
  • Phone: 423-266-3636
  • Fax: 423-266-3633
Mailing address:
  • Phone: 423-266-3636
  • Fax: 423-266-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number43
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number339
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: