Provider Information for 1205487683
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Mrs. KIMBERLY BRYANT MADISON
Sex: Female
NPI: 1205487683
Last Updated: 2023-04-19
Certification Date: 2023-04-19
Certification Date: 2023-04-19
Details
| Name | Value | ||||||||||||||||
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| NPI | 1205487683 | ||||||||||||||||
| Enumeration Date | 2019-09-26 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 1001 VILLA POINT PKWY MCDONOUGH, GA 30253-9226 United States Phone: 404-519-2639 | Fax: | ||||||||||||||||
| Primary Practice Address | 1815 N EXPRESSWAY STE B GRIFFIN, GA 30223-1185 United States Phone: 678-408-4622 | Fax: | ||||||||||||||||
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