MEDICARE: MAUDE BREAUX

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1174499073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUDE BREAUX

Provider Business Mailing Address
First Line	:	9396 FOREST KNOLL DR
Second Line	:
City	:	JONESBORO
State	:	GA
Zip	:	30238-5722
Country	:	US
Telephone Number	:	504-462-3346
Fax Number	:

Provider Business Practice Location Address
First Line	:	154 RAINBOW WAY UNIT 392
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-3994
Country	:	US
Telephone Number	:	678-770-0758
Fax Number	:

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

Provider Enumeration Date	:	10/16/2025
Last Update Date	:	10/21/2025

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Directions to “ MAUDE BREAUX ” Practice Location

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