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General NPI Number Information
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NPI Number | 1578486890
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Entity Type | Individual
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Provider Name | MADISON TANKERSLEY
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Gender | Female
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Dates
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Enumeration Date | 08/03/2026
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Last Update Date | 08/03/2026
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Provider Practice Location Address
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Address Line | 1062 THOMPSON BRIDGE RD STE B2
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City | GAINESVILLE
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State | GA
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Zip | 30501-1757
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Country | US
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Telephone | 470-252-6846
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Fax |
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Provider Business Mailing Address
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Address Line | 5807 JIM CROW RD
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City | FLOWERY BRANCH
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State | GA
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Zip | 30542-2502
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT017334
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License Number State | GA
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