MEDICARE: MADELYN R SHRUM

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	363A00000X	Physician Assistant		AZ

General Provider Information

NPI Number	:	1255131058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELYN R SHRUM

Provider Business Mailing Address
First Line	:	5742 S CROSSBOW PL
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85249-3630
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 MAIN ST SW
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-3777
Country	:	US
Telephone Number	:	480-318-1949
Fax Number	:

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

Provider Enumeration Date	:	03/19/2025
Last Update Date	:	11/25/2025

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