Provider Demographics
NPI:1114176393
Name:MADISON, GEORGE HENRY JR
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:HENRY
Last Name:MADISON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 EAST WALNUT SUITE B
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-1037
Mailing Address - Country:US
Mailing Address - Phone:812-306-5794
Mailing Address - Fax:812-962-0505
Practice Address - Street 1:1033 E WALNUT ST STE B
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-1039
Practice Address - Country:US
Practice Address - Phone:812-306-5794
Practice Address - Fax:812-962-0505
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies