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General NPI Number Information
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NPI Number | 1750180964
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Entity Type | Individual
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Provider Name | MADISON SHEA JENKINS RD
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Gender | Female
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 3620 HOWELL FERRY RD
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City | DULUTH
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State | GA
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Zip | 30096-3178
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Country | US
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Telephone | 678-312-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 645 CROSSBRIDGE ALY
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City | ALPHARETTA
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State | GA
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Zip | 30022-7561
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Country | US
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Telephone | 615-691-1171
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | LD006638
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License Number State | GA
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