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General NPI Number Information
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NPI Number | 1710331152
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Entity Type | Individual
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Provider Name | DANIELLE MADLOCK APRN
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Gender | Female
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Dates
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Enumeration Date | 04/22/2016
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 5701 MABLETON PKWY SW STE 348
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City | MABLETON
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State | GA
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Zip | 30126-3395
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Country | US
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Telephone | 470-454-3653
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Fax |
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Provider Business Mailing Address
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Address Line | 4696 BALLEY SHANNON DR SE
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City | MABLETON
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State | GA
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Zip | 30126-1763
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Country | US
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Telephone | 678-360-2368
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN208494
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN208494
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License Number State | GA
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