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General NPI Number Information
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NPI Number | 1336874684
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Entity Type | Individual
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Provider Name | MADISON ALLEN MIMS WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/20/2022
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Last Update Date | 07/20/2022
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Provider Practice Location Address
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Address Line | 1015 MANSELL RD
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City | ROSWELL
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State | GA
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Zip | 30076-1507
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Country | US
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Telephone | 770-462-0313
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Fax |
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Provider Business Mailing Address
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Address Line | 10815 MORTONS XING
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City | ALPHARETTA
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State | GA
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Zip | 30022-5626
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Country | US
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Telephone | 478-363-4224
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | RN286470
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License Number State | GA
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