MEDICARE: MADISON LINDSEY RD

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	133V00000X	Registered Dietitian	D-2234	MS

General Provider Information

NPI Number	:	1568321453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON LINDSEY RD

Provider Business Mailing Address
First Line	:	217 ROCKBRIDGE DR
Second Line	:
City	:	MADISON
State	:	MS
Zip	:	39110-6897
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 ROCKBRIDGE DR
Second Line	:
City	:	MADISON
State	:	MS
Zip	:	39110-6897
Country	:	US
Telephone Number	:	601-954-3207
Fax Number	:

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

Provider Enumeration Date	:	01/17/2026
Last Update Date	:	01/17/2026

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Directions to “ MADISON LINDSEY RD” Practice Location

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