MEDICARE: SHANNON MARIE MADISON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	35.132602	OH
2	207V00000X	Obstetrics & Gynecology Physician	68900	TN

General Provider Information

NPI Number	:	1023428588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON MARIE MADISON M.D.

Provider Business Mailing Address
First Line	:	3024 BUSINESS PARK CIR
Second Line	:
City	:	GOODLETTSVILLE
State	:	TN
Zip	:	37072-3132
Country	:	US
Telephone Number	:	615-239-2018
Fax Number	:	615-851-2018

Provider Business Practice Location Address
First Line	:	2011 MURPHY AVE STE 601
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-2220
Country	:	US
Telephone Number	:	615-329-6622
Fax Number	:	615-329-6785

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2014
Last Update Date	:	10/12/2023

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