MEDICARE: MADISON JOHNSON M.ED.,CCC-SLP

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	235Z00000X	Speech-Language Pathologist	SLP008142	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720336621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON JOHNSON M.ED.,CCC-SLP

Provider Business Mailing Address
First Line	:	613 COOK ST
Second Line	:
City	:	ROYSTON
State	:	GA
Zip	:	30662-3933
Country	:	US
Telephone Number	:	706-491-5409
Fax Number	:

Provider Business Practice Location Address
First Line	:	613 COOK ST
Second Line	:
City	:	ROYSTON
State	:	GA
Zip	:	30662-3933
Country	:	US
Telephone Number	:	706-491-5409
Fax Number	:

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

Provider Enumeration Date	:	08/27/2012
Last Update Date	:	06/24/2024

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