Healthcare Provider Details

I. General information

NPI: 1023945599
Provider Name (Legal Business Name): MADISON MORO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 MCCALLIE AVE
CHATTANOOGA TN
37403-2504
US

IV. Provider business mailing address

7172 BRAVEHEART LN
OOLTEWAH TN
37363-7132
US

V. Phone/Fax

Practice location:
  • Phone: 423-425-4111
  • Fax:
Mailing address:
  • Phone: 423-599-4879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number262411
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: