Provider Demographics
NPI:1093304933
Name:LEDFORD, MADISON J (RPH)
Entity Type:Individual
Prefix:MR
First Name:MADISON
Middle Name:J
Last Name:LEDFORD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:GA
Mailing Address - Zip Code:30728-2150
Mailing Address - Country:US
Mailing Address - Phone:706-638-1281
Mailing Address - Fax:706-638-1283
Practice Address - Street 1:1201 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:GA
Practice Address - Zip Code:30728-2150
Practice Address - Country:US
Practice Address - Phone:706-638-1281
Practice Address - Fax:706-638-1283
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH015224183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist