MEDICARE: MADISON LEIGH AKRIDGE LCSW

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	1041C0700X	Clinical Social Worker	TLHT433	FL
2	1041C0700X	Clinical Social Worker	CSW007244	GA
3	1041C0700X	Clinical Social Worker	LSW0000006449	TN
4	1041C0700X	Clinical Social Worker	C9165	MS

General Provider Information

NPI Number	:	1396883757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON LEIGH AKRIDGE LCSW

Provider Business Mailing Address
First Line	:	325 MEADOWLARK CIR
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30461-6973
Country	:	US
Telephone Number	:	901-361-3470
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 MEADOWLARK CIR
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30461-6973
Country	:	US
Telephone Number	:	662-403-7573
Fax Number	:

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

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	04/03/2025

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